Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 0430151 | KS |
NPI | 1760475115 |
---|---|
Provider Name | Roland M Darey JR. |
First Address | Wamego, KS 66547-1179 |
Second Address | Wamego, KS 66547-1179 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0430151 | KANSAS LICENSE (01) | KS |
BD6855158 | DEA (01) | |
H84998 | (02) | KS |