Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 111946 | MO |
N | 208D00000X | General Practice Physician | G7074 | TX |
NPI | 1013247675 |
---|---|
Provider Name | Dr. Arthur Samuel Keiper III |
First Address | Jefferson City, MO 65109-5752 |
Second Address | Boonville, MO 65233-1368 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2010 |
Last Update Date | 05/01/2010 |