Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 52864 | MA |
NPI | 1013935105 |
---|---|
Provider Name | Robert J Krushell |
First Address | Springfield, MA 01107-1107 |
Second Address | Springfield, MA 01107-1107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 15/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3012573 | (05) | MA |
A56991 | (02) | MD |