Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 04-16954 | KS |
Y | 208600000X | Surgeon | 04-16954 | KS |
N | 208200000X | Surgeon | 0416954 | KS |
N | 208600000X | Surgeon | 0416954 | KS |
NPI | 1013905041 |
---|---|
Provider Name | Thomas M Shields |
First Address | Manhattan, KS 66502-2777 |
Second Address | Manhattan, KS 66502-2777 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2005 |
Last Update Date | 27/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100293760A | (05) | KS |
B91015 | (02) | KS |
H91015 | (02) |