Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 2016027572 | MO |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 2016027572 | MO |
NPI | 1083096671 |
---|---|
Provider Name | Dr. Daniel O'loughlin |
First Address | Rolla, MO 65401-2980 |
Second Address | Rolla, MO 65401-2980 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2015 |
Last Update Date | 20/03/2020 |