Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0002X | Hospice and Palliative Medicine | 2016024020 | MO |
NPI | 1205195138 |
---|---|
Provider Name | Christopher Michael Black |
First Address | Joplin, MO 64803-3810 |
Second Address | Joplin, MO 64804-3503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2012 |
Last Update Date | 18/08/2016 |