Individual
DR. TEMISAN L ETIKERENTSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
20234
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20 20234
STATE REGISTRATION
SC
01
—
20234
MEDICAL LICENSE
SC
05
—
202346
—
SC
01
—
562413454
SECONDARY TAX ID
SC
01
—
562413454
FEDERAL IN
—
01
—
571134452
FEDERAL IN
—
01
—
75767
SC PCF
SC
01
—
9800859
MEDICAL LICENSE
NC
05
—
GP3438
—
SC
05
—
GP3914
—
SC
01
—
JB021564
JUA
SC
01
—
JB021584
JUA
—
Enumeration date
07/20/2005
Last updated
03/07/2023
Update your record
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