| NPI | 1366752768 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY DOVER CEO 660-542-1695 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO MD106594) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO MD109202) |
| 207R00000X Internal Medicine (Licence: MO MD106594) | |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: MO MD109202) | |
| Enumeration Date | 2010-10-19 |
| Last Update Date | 2010-10-19 |