Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 2003013364 | MO |
Y | 2081P2900X | Pain Medicine | 2003013364 | MO |
NPI | 1245276252 |
---|---|
Provider Name | Dr. Xiaohul Fan |
First Address | Farmington, MO 63640-1976 |
Second Address | Bloomsdale, MO 63627-9099 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 17/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
209158609 | (05) | MO |
43152 | HCUSA (01) | MO |
646127 | HEALTHLINK (01) | MO |
H39952 | (02) | MO |
P00702176 | MEDICARE RAILROAD (01) | MO |
P00822140 | MEDICARE RAILROAD (01) | MO |