Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 2018023693 | MO |
Y | 111NI0900X | Internist | 2018023693 | MO |
NPI | 1003320227 |
---|---|
Provider Name | Dr. Azhar Assadi |
First Address | Kirksville, MO 63501-4096 |
Second Address | Kirksville, MO 63501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2017 |
Last Update Date | 09/09/2020 |