Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 2003013945 | MO |
NPI | 1396861498 |
---|---|
Provider Name | Dr. Erich Mertensmeyer |
First Address | Springfield, MO 65804-2227 |
Second Address | Springfield, MO 65804-2227 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 25/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1396861498 | (05) | MO |
191683003 | (05) | AR |
431560263 | TRICARE (01) | MO |
I12500 | (02) | MO |
P01036353 | RR MCR (01) | MO |