Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0122X | Plastic and Reconstructive Surgery | 2009 | MO |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 2015022839 | MO |
NPI | 1124255666 |
---|---|
Provider Name | Thomas William Mcewan |
First Address | Kansas City, MO 64131-4517 |
Second Address | Kansas City, MO 64111-5941 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2009 |
Last Update Date | 05/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2015022839 | LICENSE (01) | MO |