Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 04-20748 | KS |
NPI | 1003972613 |
---|---|
Provider Name | Martin A Mainster |
First Address | Kansas City, KS 66160-0001 |
Second Address | Kansas City, KS 66160-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11506041 | BCBS KANSAS CITY (01) | MO |
C51171 | (02) |