Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | ||
N | 222Z00000X | Podiatrist | ||
Y | 224P00000X | Prosthetist |
NPI | 1083027205 |
---|---|
Provider Name | Michael L Darby |
First Address | Columbia, MO 65201-6500 |
Second Address | Columbia, MO 65201-6500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2014 |
Last Update Date | 05/08/2014 |