Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0402X | Child Neurologist | 32244 | MO |
Y | 2084N0402X | Child Neurologist | D9772 | TX |
NPI | 1043390487 |
---|---|
Provider Name | Robert Cruse |
First Address | Kansas City, MO 64108 |
Second Address | Kansas City, MO 64108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 30/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E80761 | (02) |