Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 2017021689 | MO |
NPI | 1013433564 |
---|---|
Provider Name | Ashutosh Pandey |
First Address | Columbia, MO 65212-1000 |
Second Address | Columbia, MO 65212-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2017 |
Last Update Date | 16/08/2017 |