Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 04-23383 | KS |
N | 207X00000X | Orthopaedic Surgeon | 105477 | MO |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 105477 | MO |
NPI | 1114919982 |
---|---|
Provider Name | Scott R Luallin |
First Address | Kansas City, MO 64108-2602 |
Second Address | Kansas City, MO 64139-1236 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2005 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200027744 | RAILROAD MEDICARE (01) | KS |
F74924 | (02) |