Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 104716 | MO |
N | 2081P2900X | Pain Medicine | 104716 | MO |
NPI | 1255478970 |
---|---|
Provider Name | Dr. Thomas B. Corsolini |
First Address | Springfield, MO 65804 |
Second Address | Springfield, MO 65804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 24/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
206847808 | (05) | MO |
B52212 | (02) | MO |