Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 0526010 | KS |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 3367 | OK |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | R5N23 | MO |
NPI | 1457331324 |
---|---|
Provider Name | Kent Douglas Mcintire |
First Address | Joplin, MO 64803-3810 |
Second Address | Joplin, MO 64804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2006 |
Last Update Date | 07/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
247988108 | (05) | MO |
9102 | BLUE CROSS (01) | MO |
E65941 | (02) |