Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 686 | MO |
NPI | 1265588479 |
---|---|
Provider Name | Dr. Lorene Ann Van Dam |
First Address | Springfield, MO 65802-7710 |
Second Address | Springfield, MO 65802-7710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2007 |
Last Update Date | 10/06/2010 |