Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | R4J45 | MO |
NPI | 1013980614 |
---|---|
Provider Name | Dr. Andrew Sinclair Pavlovich |
First Address | Lees Summit, MO 64064-2368 |
Second Address | Lees Summit, MO 64064 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2006 |
Last Update Date | 15/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1008053 | UHC (01) | MO |
15072030 | BCBS OF KC (01) | MO |
204510882 | CHAMPUS (01) | MO |
4082857 | AETNA (01) | MO |
E07433 | (02) | MO |