| # |
Provider Identifier |
Provider Identifier Type |
Provider Identifier State |
Provider Identifier Issuer |
| 1 | 25MA11191500 | OTHER | NJ | NEW JERSEY |
| 2 | 33739 | OTHER | NE | NEBRASKA MEDICAL LICENSE |
| 3 | 42609 | OTHER | AL | ALABAMA MEDICAL LICENSE |
| 4 | 76339 | OTHER | WI | WISCONSIN MEDICAL LICENSE |
| 5 | D0092430 | OTHER | MD | MARYLAND MEDICAL LICENSE |
| 6 | MD24935 | OTHER | ME | MAINE MEDICAL LICENSE |
| 7 | MED-PHYS-LIC-99482 | OTHER | MT | MONTANA MEDICAL LICENSE |
| 8 | 36157146 | OTHER | IL | ILLINOIS MEDICAL LICENSE |
| 9 | 89503 | OTHER | GA | GEORGIA MEDICAL LICENSE |
| 10 | M-15901 | OTHER | ID | IDAHO MEDICAL LICENSE |
| 11 | MD.MD.61175718 | OTHER | WA | WASHINGTON MEDICAL LICENSE |
| 12 | 12839 | OTHER | SD | SOUTH DAKOTA MEDICAL LICENSE |
| 13 | 21332 | OTHER | NV | NEVADA MEDICAL LICENSE |
| 14 | 310885 | OTHER | NY | NEW YORK MEDICAL LICENSE |
| 15 | 328228 | OTHER | LA | LOUISIANA MEDICAL LICENSE |
| 16 | 38429 | OTHER | OK | OKLAHOMA MEDICAL LICENSE |
| 17 | 4301505093 | OTHER | MI | MICHIGAN MEDICAL LICENSE |
| 18 | 69112 | OTHER | CT | CONNECTICUT MEDICAL LICENSE |
| 19 | DR.0066706 | OTHER | CO | COLORADO MEDICAL LICENSE |
| 20 | T2572 | OTHER | TX | TEXAS MEDICAL LICENSE |
| 21 | 176790 | OTHER | AK | ALASKA MEDICAL LICENSE |
| 22 | 2021-02468 | OTHER | NC | NORTH CAROLINA MEDICAL LICENSE |
| 23 | 290109 | OTHER | MA | MASSACHUSETTS MEDICAL LICENSE |
| 24 | 35.142712 | OTHER | OH | OHIO MEDICAL LICENSE |
| 25 | 55847 | OTHER | KY | KENTUCKY MEDICAL LICENSE |
| 26 | 63956 | OTHER | TN | TENNESSEE MEDICAL LICENSE |
| 27 | 72632 | OTHER | MN | MINNESOTA MEDICAL LICENSE |
| 28 | A144337 | OTHER | CA | CALIFORNIA MEDICAL LICENSE |
| 29 | E-14484 | OTHER | AR | ARKANSAS MEDICAL LICENSE |
| 30 | MD2021-0636 | OTHER | NM | NEW MEXICO |
| 31 | MD210001353 | OTHER | DC | DC MEDICAL LICENSE |
| 32 | 01085912A | OTHER | IN | INDIANA MEDICAL LICENSE |
| 33 | 13793A | OTHER | WY | WYOMING MEDICAL LICENSE |
| 34 | 444908 | OTHER | KS | KANSAS MEDICAL LICENSE |
| 35 | C1-0024474 | OTHER | DE | DELAWARE MEDICAL LICENSE |
| 36 | MD205616 | OTHER | OR | OREGON MEDICAL LICENSE |
| 37 | MD-22037 | OTHER | HI | HAWAII MEDICAL LICENSE |
| 38 | MD17872 | OTHER | RI | RHODE ISLAND MEDICAL LICENSE |
| 39 | ME127579 | OTHER | FL | FLORIDA MEDICAL LICENSE |
| 40 | 12328678-1205 | OTHER | UT | UTAH MEDICAL LICENSE |
| 41 | 17630 | OTHER | ND | NORTH DAKOTA MEDICAL LICENSE |
| 42 | 2021033997 | OTHER | MO | MISSOURI MEDICAL LICENSE |
| 43 | MD-48908 | OTHER | IA | IOWA MEDICAL LICENSE |
| 44 | MD474919 | OTHER | PA | PENNSYLVANIA MEDICAL LICENSE |
| 45 | 0101272120 | OTHER | VA | VIRGINIA MEDICAL LICENSE |
| 46 | 21645 | OTHER | NH | NEW HAMPSHIRE |
| 47 | 29169 | OTHER | MS | MISSISSIPPI MEDICAL LICENSE |
| 48 | 30538 | OTHER | WV | WEST VIRGINIA MEDICAL LICENSE |
| 49 | 64111 | OTHER | AZ | ARIZONA MEDICAL LICENSE |
| 50 | 86375 | OTHER | SC | SOUTH CAROLINA MEDICAL LICENSE |