Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 2005002091 | MO |
NPI | 1205944105 |
---|---|
Provider Name | Dr. Robert Lee Swords |
First Address | Springfield, MO 65801-5681 |
Second Address | Springfield, MO 65806-1102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 28/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
401049200 | (05) | MO |