Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 05-25562 | KS |
NPI | 1164494506 |
---|---|
Provider Name | Prof. Bennett L Radford |
First Address | Salina, KS 67401-5103 |
Second Address | Salina, KS 67401-5103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2006 |
Last Update Date | 28/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100302190C | (05) | KS |
106603 | MEDICARE ID# (01) | KS |
G24861 | (02) | KS |