Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 35084045 | OH |
N | 208600000X | Surgeon | 35084045 | OH |
Y | 2086X0206X | Surgical Oncologist | M6740 | TX |
NPI | 1326259623 |
---|---|
Provider Name | Joshua Matthew Varghise Mammen |
First Address | Kansas City, KS 66103-2937 |
Second Address | Kansas City, KS 66103-2937 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2007 |
Last Update Date | 30/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8AG961 | BLUE CROSS BLUE SHIELD (01) |