Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 04-39942 | KS |
NPI | 1013336320 |
---|---|
Provider Name | Stephanie Thom |
First Address | Kansas City, KS 66160 |
Second Address | Kansas City, KS 66160 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2014 |
Last Update Date | 04/03/2019 |