Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 6037 | SD |
NPI | 1053389130 |
---|---|
Provider Name | Masaru Chiba |
First Address | Rapid City, SD 57701-6000 |
Second Address | Rapid City, SD 57701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 06/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F88679 | (02) | SD |