Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | MD102249 | MO |
Y | 207PE0004X | Emergency Medical Services | MD102249 | MO |
NPI | 1003815135 |
---|---|
Provider Name | Thomas Deskin |
First Address | Shawnee Mission, KS 66201-2747 |
Second Address | Kansas City, MO 64114-4673 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2005 |
Last Update Date | 18/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
19454039 | BLUE CROSS BLUE SHIELD (01) | |
CU0181 | RAILROAD MEDICARE (01) | MO |
F57156 | (02) | MO |