Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 2020017652 | MO |
Y | 208600000X | Surgeon | 2020017652 | MO |
NPI | 1013300490 |
---|---|
Provider Name | Alice Lee |
First Address | Kansas City, MO 64184-3966 |
Second Address | Columbia, MO 65212-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2015 |
Last Update Date | 21/09/2020 |