Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 18203 | MS |
N | 111NI0900X | Internist | 18203 | MS |
Y | 207RG0100X | Gastroenterologist | 10468A | WY |
NPI | 1033129390 |
---|---|
Provider Name | Kenneth Buran |
First Address | Cheyenne, WY 82009-2667 |
Second Address | Cheyenne, WY 82009-2667 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 19/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G23886 | (02) | MS |