Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MDR1K87 | MO |
NPI | 1033184007 |
---|---|
Provider Name | Dr. Robert J Mcdonald JR. |
First Address | Jefferson City, MO 65109-5715 |
Second Address | Jefferson City, MO 65109-5715 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 01/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
206789521 | (05) | MO |
24321 | BLUE CROSS BLUE SHIELD (01) | |
P00061459 | RAILROAD MEDICARE (01) | MO |