Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | R9438 | MO |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | R9438 | MO |
NPI | 1023055746 |
---|---|
Provider Name | David D Cravens |
First Address | Kansas City, MO 64184-3966 |
Second Address | Columbia, MO 65201-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 06/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200705531 | (05) | MO |
A13243 | (02) |