Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 2017020735 | MO |
N | 207X00000X | Orthopaedic Surgeon | 33367 | IA |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 33367 | IA |
NPI | 1457355810 |
---|---|
Provider Name | John F Nettrour |
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 | 13/06/2005 |
Last Update Date | 26/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1209171 | (05) | IA |
577518300 | (05) | MN |
G43451 | (02) |