Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 2019009919 | MO |
NPI | 1184018632 |
---|---|
Provider Name | Christopher Amundsen |
First Address | Branson, MO 65616-3725 |
Second Address | Branson, MO 65616 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2015 |
Last Update Date | 04/09/2019 |