Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 36275 | MO |
NPI | 1033104005 |
---|---|
Provider Name | Dr. James S. Denninghoff |
First Address | Columbia, MO 65201-8018 |
Second Address | Columbia, MO 65201-8018 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2005 |
Last Update Date | 24/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
202330700 | (05) | MO |
A10415 | (02) | MO |