Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 2016043686 | MO |
NPI | 1013295419 |
---|---|
Provider Name | Dr. Joel Amos Leon Becerril |
First Address | Rolla, MO 65401-2905 |
Second Address | Rolla, MO 65401-2905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2011 |
Last Update Date | 14/01/2021 |