Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 5153 | SD |
NPI | 1164522751 |
---|---|
Provider Name | Richard C Tenglin |
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 | 23/09/2006 |
Last Update Date | 03/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H81414 | (02) |