Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | R2C39 | MO |
NPI | 1003852054 |
---|---|
Provider Name | Johnny L Venter |
First Address | Carthage, MO 64836-7402 |
Second Address | Carthage, MO 64836-7402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 08/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100184420A | (05) | OK |
100229510B | (05) | KS |
241713916 | (05) | MO |
A25080 | (02) |