Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | MO13663 | MO |
NPI | 1023234531 |
---|---|
Provider Name | Dr. Gerard R Feldhaus |
First Address | Liberty, MO 64068-3459 |
Second Address | Claycomo, MO 64119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 08/07/2007 |