Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 2021010406 | MO |
N | 207Q00000X | Family Doctor | 3714 | OK |
N | 207Q00000X | Family Doctor | DO05122 | IA |
NPI | 1003814179 |
---|---|
Provider Name | Michael D David |
First Address | Joplin, MO 64803-3810 |
Second Address | Joplin, MO 64804-4034 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2005 |
Last Update Date | 05/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100197510C | OSU-INDIVIDUAL (01) | OK |
100197510E | (05) | OK |
200470610D | OSU-GROUP (01) | OK |
200505990B | (05) | OK |