Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 2002004006 | MO |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 2002004006 | MO |
NPI | 1104805381 |
---|---|
Provider Name | Craig W. Naugle |
First Address | Springfield, MO 65804 |
Second Address | Springfield, MO 65804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2006 |
Last Update Date | 24/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
156131 | BLUECROSS BLUESHIELD (01) | |
205957103 | (05) | MO |
H27279 | (02) | MO |