| NPI | 1245277631 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STUART G STANGELAND Chief Operating Officer 417-820-3873 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 152W00000X Optometrist |
| 152W00000X Optometrist (Licence: MO T002235) | |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: MO T002235) | |
| 156FX1800X Technician/Technologist, Optician | |
| 204E00000X Oral & Maxillofacial Surgery | |
| 207KA0200X Allergy & Immunology, Allergy | |
| 207LP2900X Anesthesiology, Pain Medicine | |
| 207N00000X Dermatology | |
| 207R00000X Internal Medicine | |
| 207RH0003X Internal Medicine, Hematology & Oncology | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2018-05-17 |