is a Geriatric Medicine in , . practices all healthcare services and medical treatments related to Geriatric Medicine. The NPI Number for is 1225080682. The last update date is .
's current location address is , , . You can contact this provider via phone number . The mailing address for is , , . To know further, please read the information below!
Provider Profile Detail
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| Address | , , |
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| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1225080682 |
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| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | |
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| State | () |
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Provider's Primary Taxonomy Detail
| Speciality | Geriatric Medicine |
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| Taxonomy | 207Qg0300X |
| Licence No | 4032538 |
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Definition: A family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 201906013 | MO | -- | |
| 10196264 | VA | -- | |
| P00284544 | MO | RR MEDICARE |
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