Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | R4B70 | MO |
NPI | 1295842342 |
---|---|
Provider Name | Generoso Guzman |
First Address | Hayti, MO 63851-1738 |
Second Address | Hayti, MO 63851-1738 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 25/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201041613 | (05) | MO |
C38132 | (02) | MO |