Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 2001033337 | MO |
NPI | 1013040641 |
---|---|
Provider Name | Aaron Thomas Andrews |
First Address | Jackson, MO 63755-0437 |
Second Address | Jackson, MO 63755-2957 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 07/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
151901 | BCBS (01) | MO |
43-1946838 | TAX ID (01) | MO |
470763 | HEALTHLINK (01) | MO |
U87802 | (02) | MO |