Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 3247 | AZ |
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 63011-21 | WI |
NPI | 1619903846 |
---|---|
Provider Name | Jonathon R Kirsch |
First Address | Kirksville, MO 63501-1443 |
Second Address | Kirksville, MO 63501-1443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 17/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
390732 | (05) | AZ |
G60608 | (02) |