Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | R8P78 | MO |
NPI | 1194770883 |
---|---|
Provider Name | Ann A Gassman |
First Address | Belton, MO 64012-1730 |
Second Address | Belton, MO 64012-1730 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 09/07/2007 |