Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 01070687A | IN |
Y | 207PE0004X | Emergency Medical Services | 054094 | MI |
NPI | 1124054929 |
---|---|
Provider Name | Robert Britton |
First Address | Niles, MI 49120-9457 |
Second Address | Niles, MI 49120-9457 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 05/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104979518 | (05) | MI |
4725463 | (05) | MI |
4725472 | (05) | MI |
E08120 | (02) | MI |
RB054094 | BC/BS (01) | MI |