Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | DE014017 | MO |
NPI | 1326019837 |
---|---|
Provider Name | Dr. Mitchell Duane Esquibel |
First Address | Rolla, MO 65401-4416 |
Second Address | Rolla, MO 65401-4416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2006 |
Last Update Date | 08/07/2007 |