Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 42035 | MN |
N | 2080N0001X | Neonatal-Perinatal Doctor | 04-34019 | KS |
Y | 2080N0001X | Neonatal-Perinatal Doctor | 2006025325 | MO |
NPI | 1023081791 |
---|---|
Provider Name | Joshua E Petrikin |
First Address | Kansas City, MO 64108-4619 |
Second Address | Kansas City, MO 64108-4619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
923162500 | (05) | MN |
H03116 | (02) |