Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 7141 | NE |
NPI | 1003227919 |
---|---|
Provider Name | Joshua Sypal |
First Address | David City, NE 68632-2116 |
Second Address | David City, NE 68632-2116 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2014 |
Last Update Date | 20/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
086366 | (02) | |
093482 | (02) | |
47055317300 | (05) | NE |
47055317313 | (05) | NE |