| NPI | 1841810306 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA EVANS Credentialing Personal 573-944-3604 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery Orthopaedic Surgery of the Spine |
| Additional Taxonomies | 174400000X Specialist |
| 207R00000X Internal Medicine | |
| 207X00000X Orthopaedic Surgery | |
| 208VP0000X Pain Medicine Pain Medicine | |
| 208VP0014X Pain Medicine Interventional Pain Medicine | |
| 261Q00000X Clinic/Center | |
| 261QP3300X Clinic/Center Pain | |
| Enumeration Date | 2020-04-24 |
| Last Update Date | 2020-04-24 |