Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | R4861 | MO |
NPI | 1023120110 |
---|---|
Provider Name | Dr. James Mead Gaunt |
First Address | Sedalia, MO 65301-7542 |
Second Address | Sedalia, MO 65301-7542 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 16/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E48327 | (02) | MO |