Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 3443 | SD |
NPI | 1073540738 |
---|---|
Provider Name | Mark A Vossler |
First Address | Clear Lake, SD 57226-5442 |
Second Address | Clear Lake, SD 57226-5442 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6002372 | (05) | SD |