Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 012097 | MO |
NPI | 1053791418 |
---|---|
Provider Name | John Rapley |
First Address | Kansas City, MO 64108-2716 |
Second Address | Kansas City, MO 64108-2784 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2015 |
Last Update Date | 01/06/2015 |