Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 2004025520 | MO |
NPI | 1174559116 |
---|---|
Provider Name | Minh-Thu Ngoc Le |
First Address | Springfield, MO 65808-9007 |
Second Address | Springfield, MO 65807-5155 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 27/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
209867209 | (05) | MO |