Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CH0003672 | FL |
NPI | 1982730198 |
---|---|
Provider Name | John William Kurpa |
First Address | Grand Ridge, FL 32442-3952 |
Second Address | Marianna, FL 32446-8235 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2007 |
Last Update Date | 19/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
88670 | BLUE CROSS/ BLUE SHIELD (01) | FL |
CHOOO3672 | CHIROPRACTIC LICENSE (01) | FL |
T84701 | (02) | FL |