Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 18479 | NE |
NPI | 1003036377 |
---|---|
Provider Name | Rajesh Kumar |
First Address | Lincoln, NE 68510 |
Second Address | Lincoln, NE 68510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E40928 | (02) |