Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081S0010X | Sports Medicine | 04-38924 | KS |
N | 213ES0000X | Sports Medicine | 04-38924 | KS |
Y | 2081S0010X | Sports Medicine | 2016012362 | MO |
Y | 213ES0000X | Sports Medicine | 2016012362 | MO |
NPI | 1144519877 |
---|---|
Provider Name | Seth Marcus Oliphant |
First Address | Kansas City, MO 64131-4517 |
Second Address | Kansas City, MO 64111-3498 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2011 |
Last Update Date | 05/12/2017 |