Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 2018024604 | MO |
Y | 213ES0000X | Sports Medicine | 2018024604 | MO |
NPI | 1487134722 |
---|---|
Provider Name | Connor Parrish |
First Address | Springfield, MO 65804-4615 |
Second Address | Springfield, MO 65804-7328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2018 |
Last Update Date | 16/08/2018 |