is a Gynecologic Oncology in , . practices all healthcare services and medical treatments related to Gynecologic Oncology. The NPI Number for is 1720030349. 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 | 1720030349 |
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| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | |
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| City | |
| State | () |
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Provider's Primary Taxonomy Detail
| Speciality | Gynecologic Oncology |
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| Taxonomy | 207Vx0201X |
| Licence No | 36615 |
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Definition: An obstetrician/gynecologist who provides consultation and comprehensive management of patients with gynecologic cancer, including those diagnostic and therapeutic procedures necessary for the total care of the patient with gynecologic cancer and res |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 203568324 | MO | -- | |
| 160306001 | AR | -- | |
| P00262024 | RAILROAD MEDICARE | ||
| 188833 | HEALTHLINK | ||
| 444830 | MO | ANTHEM BCBS |
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