Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 16963 | MS |
NPI | 1003892357 |
---|---|
Provider Name | Mr. Daniel L Venarske |
First Address | Jackson, MS 39216 |
Second Address | Jackson, MS 39216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2005 |
Last Update Date | 28/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00125626 | (05) | MS |
H46388 | (02) |