Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | R8261 | MO |
NPI | 1538388061 |
---|---|
Provider Name | Dr. Lirio Maxino Reyes |
First Address | Springfield, MO 65804 |
Second Address | Springfield, MO 65804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B18385 | (02) |