Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 20473 | NE |
NPI | 1043302748 |
---|---|
Provider Name | John N Kabalin |
First Address | Scottsbluff, NE 69361-4617 |
Second Address | Scottsbluff, NE 69361-4617 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F28145 | (02) | NE |