Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 3818 | SD |
NPI | 1053357962 |
---|---|
Provider Name | Tamara Poling |
First Address | Rapid City, SD 57701-5462 |
Second Address | Rapid City, SD 57701-5462 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 05/11/2007 |