Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | IL |
NPI | 1013018555 |
---|---|
Provider Name | Douglas Scott Ham |
First Address | Springfield, MO 65804-7210 |
Second Address | Springfield, MO 65802-1917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 21/02/2008 |