Individual
MR. JOHN S. DYKSTRA X
Active
Individual
MR. JOHN S. DYKSTRA X
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
0516561
KS
2085R0202X
Diagnostic Radiology Physician
Primary
R4721
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03870079
BCBS
MO
01
—
067407
BCBS
KS
05
—
100231260A
—
KS
01
—
2239077
AETNA
MO
05
—
240394122
—
MO
Enumeration date
11/23/2005
Last updated
09/28/2010
Update your record
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