Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 117380 | MO |
N | 208600000X | Surgeon | 117380 | MO |
Y | 2086S0129X | Vascular Surgeon | 117380 | MO |
N | 2086S0129X | Vascular Surgeon | 25764 | NC |
NPI | 1174621379 |
---|---|
Provider Name | Kevin P Rankin |
First Address | Sikeston, MO 63801-5043 |
Second Address | Sikeston, MO 63801-5043 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 28/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
203829916 | (05) | MO |
C29055 | (02) |