Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 2016023437 | MO |
Y | 111NI0900X | Internist | 2016023437 | MO |
NPI | 1003253782 |
---|---|
Provider Name | Dr. Andre Joel Arsenault |
First Address | Saint Joseph, MO 64506-3488 |
Second Address | Saint Joseph, MO 64506-3488 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2013 |
Last Update Date | 18/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10026591700 | (05) | NE |
1003253782 | (05) | IA |
1003253782 | (05) | MO |
201147790A | (05) | KS |
701000340 | (02) | MO |
P01703873 | RR MEDCIARE (01) | MO |