Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | R2F40 | MO |
NPI | 1043203748 |
---|---|
Provider Name | Mignon M Makos |
First Address | Rolla, MO 65402 |
Second Address | Rolla, MO 65401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2005 |
Last Update Date | 22/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
202550208 | (05) | MO |
C50912 | (02) | |
C50912 | (02) | MO |