Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 32525 | WA |
N | 207P00000X | Emergency Physician | 4491 | AK |
N | 207P00000X | Emergency Physician | G64110 | CA |
N | 207R00000X | Internist | 32525 | WA |
N | 111NI0900X | Internist | 32525 | WA |
N | 207R00000X | Internist | 4491 | AK |
N | 111NI0900X | Internist | 4491 | AK |
N | 207R00000X | Internist | G64110 | CA |
N | 111NI0900X | Internist | G64110 | CA |
NPI | 1003872748 |
---|---|
Provider Name | Scott Myers Kirchner |
First Address | Ketchikan, AK 99901-1162 |
Second Address | Ketchikan, AK 99901-5746 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F24838 | (02) | CA |
MD9748 | (05) | AK |