Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 112077 | MO |
NPI | 1760521660 |
---|---|
Provider Name | Dr. Robert E Sonnemaker |
First Address | Springfield, MO 65801-2580 |
Second Address | Springfield, MO 65804-2203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 15/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
132094001 | (05) | AR |
173098 | MO BLUE SHIELD (01) | MO |
208723304 | (05) | MO |
81454 | ARK BLUE SHIELD (01) | AR |
B63822 | (02) |