Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 2007033579 | MO |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | E3902 | AR |
N | 207YP0228X | Pediatric Otolaryngology | 2007033579 | MO |
N | 207YP0228X | Pediatric Otolaryngology | E3902 | AR |
NPI | 1508868951 |
---|---|
Provider Name | Dr. Eliav Gov-Ari |
First Address | Columbia, MO 65205-7687 |
Second Address | Columbia, MO 65201-6633 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 15/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
154271001 | (05) | AR |
I03986 | (02) | AR |