Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | 105280 | MO |
Y | 208000000X | Pediatrician | 105280 | MO |
N | 2080A0000X | Adolescent Medicine | 105280 | MO |
NPI | 1043259351 |
---|---|
Provider Name | Mark A Wulff |
First Address | Kansas City, MO 64111-2659 |
Second Address | Kansas City, MO 64111-2659 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 14/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
207748617 | (05) | MO |