Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 117878 | MO |
NPI | 1023064235 |
---|---|
Provider Name | Dr. James M Frogge |
First Address | Joplin, MO 64803-3810 |
Second Address | Joplin, MO 64804-3648 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 18/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
203968102 | (05) | MO |
F76810 | (02) | MO |