Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 2010029569 | MO |
N | 207YS0123X | Facial Plastic Surgeon | 2010029569 | MO |
NPI | 1588865091 |
---|---|
Provider Name | Joshua L Hentzelman |
First Address | Saint Louis, MO 63110-2520 |
Second Address | Saint Louis, MO 63104-1016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2007 |
Last Update Date | 17/02/2021 |