Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | R8C00 | MO |
NPI | 1033167424 |
---|---|
Provider Name | Sue A Brown |
First Address | Kansas City, MO 64108-2634 |
Second Address | Kansas City, MO 64108-2640 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 19/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C51481 | (02) | MO |