Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0402X | Child Neurologist | 38218 | MN |
Y | 2084N0402X | Child Neurologist | OS16527 | FL |
NPI | 1407893753 |
---|---|
Provider Name | Richard Jess Kanoff |
First Address | Duluth, MN 55805-1951 |
Second Address | Saint Petersburg, FL 33701-4804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 04/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
101525700 | (05) | MN |
F96640 | (02) |