Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 04-21464 | KS |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 04-21464 | KS |
N | 207QS0010X | Family Doctor - Sports Medicine | 04-21464 | KS |
NPI | 1235241779 |
---|---|
Provider Name | Robert P Moser JR. |
First Address | Wichita, KS 67214-3124 |
Second Address | Wichita, KS 67214-4914 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 31/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D92339 | (02) | KS |