Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 5836 | MO |
NPI | 1063654499 |
---|---|
Provider Name | Dr. Kiet A Le |
First Address | Springfield, MO 65803-4606 |
Second Address | Springfield, MO 65803-4606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2009 |
Last Update Date | 31/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T93229 | (02) | MO |