Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | DO20644 | OR |
NPI | 1124001862 |
---|---|
Provider Name | Robert A Mairs |
First Address | Payette, ID 83661-5420 |
Second Address | Ontario, OR 97914-4516 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2005 |
Last Update Date | 03/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
804163300 | (05) | ID |