Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 2012001985 | MO |
NPI | 1043207483 |
---|---|
Provider Name | James Clinton Denneny III |
First Address | Columbia, MO 65212-0001 |
Second Address | Columbia, MO 65212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2005 |
Last Update Date | 30/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
040003145 | RAILROAD MEDICARE (01) | TN |
3023690 | (05) | TN |
A98761 | (02) | TN |