Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 12909 | NV |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | MD041982L | PA |
NPI | 1295840841 |
---|---|
Provider Name | John J Kastrup |
First Address | Las Vegas, NV 89128-4356 |
Second Address | Henderson, NV 89074-8194 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 28/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
279524800 | (05) | FL |
68052 | BCBS (01) | FL |
F82139 | (02) | |
P00451374 | RAILROAD MEDICARE (01) | FL |