Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RX0202X | Medical Oncology | 31350 | NE |
NPI | 1043325228 |
---|---|
Provider Name | Jack M Lionberger |
First Address | Saint Louis, MO 63128-2106 |
Second Address | Lincoln, NE 68502-3704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 07/01/2019 |