Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 04-29554 | KS |
NPI | 1942302625 |
---|---|
Provider Name | Pastor Ruiz Causin JR. |
First Address | Wichita, KS 67218-2416 |
Second Address | Wichita, KS 67226-8175 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2006 |
Last Update Date | 11/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B46886 | (02) | KS |