Facts
- Status
- A
- Credential
- MD
- Type
- Individual
- Enumeration date
- 2006-09-16
- Last updated
- 2013-05-16
Specialties
Licenses
- License MO
- R5J37
Location
- Practice location
- 1235 E CHEROKEE ST
- City
- SPRINGFIELD MO
- Postal code
- 658042203
- Phone
- 417-820-2000
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.