Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 2012009705 | MO |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | N9802 | TX |
NPI | 1366553323 |
---|---|
Provider Name | Alan Garvin Anz |
First Address | Columbia, MO 65201-7199 |
Second Address | Columbia, MO 65201-7199 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 24/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104180022 | PTAN (01) | MO |