Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | CP003241 | NE |
NPI | 1215227780 |
---|---|
Provider Name | Thomas Masters |
First Address | Omaha, NE 68130-2654 |
Second Address | Omaha, NE 68130-2654 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2011 |
Last Update Date | 10/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
16982594 | PERSONAL-UNIQUE (01) | NE |