Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 2005019100 | MO |
NPI | 1154520757 |
---|---|
Provider Name | Dr. Nathan Seth Box |
First Address | Joplin, MO 64803-3810 |
Second Address | Joplin, MO 64804-1601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2007 |
Last Update Date | 06/07/2010 |