Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 25096 | KS |
N | 207RS0012X | Sleep Medicine | 0425096 | KS |
N | 207RS0012X | Sleep Medicine | 106596 | MO |
N | 207RS0012X | Sleep Medicine | 35879 | IA |
NPI | 1043203698 |
---|---|
Provider Name | Scott E Eveloff |
First Address | Lees Summit, MO 64064-2336 |
Second Address | Lees Summit, MO 64064-2336 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2005 |
Last Update Date | 23/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1460089 | (05) | IA |
2460089 | (05) | IA |
E51383 | (02) | KS |
IB1362003 | (02) | IA |