Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 35-094877 | OH |
NPI | 1659597136 |
---|---|
Provider Name | Kevin Paul Baehl |
First Address | Springfield, MO 65804-6530 |
Second Address | Springfield, MO 65807-5210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 26/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3047027 | (05) | OH |