Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 2004030330 | MO |
N | 208600000X | Surgeon | 2004030330 | MO |
Y | 2086S0102X | Surgical Critical Care | 2004030330 | MO |
NPI | 1114139383 |
---|---|
Provider Name | Jeffrey P Coughenour |
First Address | Kansas City, MO 64184-3966 |
Second Address | Columbia, MO 65212-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 07/10/2019 |