Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 000314 | MO |
NPI | 1174621056 |
---|---|
Provider Name | Dr. Robert R Shemwell |
First Address | Excelsior Springs, MO 64024-0535 |
Second Address | Camdenton, MO 65020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 16/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04076032 | BC KC (01) | |
196587 | BC (01) | |
308885854 | (05) | MO |
P00203429 | RR MCR (01) | |
T42383 | (02) | MO |