Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CE#6565 | MO |
NPI | 1003981895 |
---|---|
Provider Name | Dr. James Daley Robart Jr. |
First Address | Potosi, MO 63664-2101 |
Second Address | Potosi, MO 63664 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 14/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110399 | BCBS AND BLUECHOICE (01) | MO |
350044981 | RAILROAD MEDICARE NUMBER (01) | MO |
431836615 | AETNA, MERCY, FIRST HEALT (01) | MO |
431836615 | HEALTHLINK AND PHCSNUMBER (01) | MO |
756252300 | (05) | MO |
U66778 | (02) | MO |