Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | R5N45 | MO |
NPI | 1003878141 |
---|---|
Provider Name | Dr. Gerald Wayne Englund |
First Address | Joplin, MO 64803-3810 |
Second Address | Neosho, MO 64850-1769 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2006 |
Last Update Date | 07/04/2021 |