Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 2007015046 | MO |
NPI | 1154527190 |
---|---|
Provider Name | Jonathan Amspacher |
First Address | Saint Joseph, MO 64506-1211 |
Second Address | Saint Joseph, MO 64506-1211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2007 |
Last Update Date | 17/03/2018 |