Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | R3J75 | MO |
N | 207PE0004X | Emergency Medical Services | R3J75 | MO |
NPI | 1083785604 |
---|---|
Provider Name | Donald Raymond Ash |
First Address | Cameron, MO 64429-2400 |
Second Address | Cameron, MO 64429-2400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 03/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
243332046 | (05) | MO |
E48366 | (02) | MO |