Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 113752 | MO |
NPI | 1063509404 |
---|---|
Provider Name | Dr. David Lee Sommerfeld |
First Address | Springfield, MO 65804-2219 |
Second Address | Springfield, MO 65804-2219 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 01/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004012599 | MEDICARE PTAN (01) | MO |
113768 | BLUE CROSS BLUE SHIELD (01) | |
15377001 | (05) | AR |
209733815 | (05) | MO |
329974 | HEALTHLINK (01) | |
390005293 | RAILROAD MEDICARE (01) | |
E92178 | (02) |