Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | 04-29123 | KS |
N | 2080P0205X | Pediatric Endocrinologist | 2001016013 | MO |
NPI | 1174555957 |
---|---|
Provider Name | Larry Kurt Midyett |
First Address | Overland Park, KS 66215-2307 |
Second Address | Overland Park, KS 66213-1324 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 02/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
208309708 | (05) | MO |
H79628 | (02) |