Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 2017018862 | MO |
NPI | 1003337809 |
---|---|
Provider Name | Dr. Andrew John Vanbruggen |
First Address | Joplin, MO 64804-3643 |
Second Address | Joplin, MO 64804-3643 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2017 |
Last Update Date | 30/06/2017 |