Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 2009030553 | MO |
Y | 208D00000X | General Practice Physician | 2009030553 | MO |
NPI | 1023345923 |
---|---|
Provider Name | David Loris Dollins |
First Address | Brookfield, MO 64628-2337 |
Second Address | Brookfield, MO 64628-2337 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2009 |
Last Update Date | 30/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
129910007 | (02) | MO |