Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 04-21348 | KS |
NPI | 1073576302 |
---|---|
Provider Name | Mark Jeffrey Maslan |
First Address | Overland Park, KS 66211-1630 |
Second Address | Overland Park, KS 66211-1630 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2006 |
Last Update Date | 12/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
202403002 | (05) | MO |
2050277901 | (05) | KS |
C50816 | (02) |