Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RP1001X | Pulmonary Disease | 036053136 | IL |
Y | 207RP1001X | Pulmonary Disease | 2004018055 | MO |
NPI | 1013913870 |
---|---|
Provider Name | James V Vest |
First Address | Osage Beach, MO 65065-1500 |
Second Address | Osage Beach, MO 65065-3050 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2005 |
Last Update Date | 30/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036053136 | (05) | IL |
1013913870 | (05) | MO |
C41639 | (02) | IL |
P01103084 | RAILROAD MEDICARE (01) | MO |