Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 01058585A | IN |
Y | 2080P0214X | Pediatric Pulmonologist | 2018039696 | MO |
NPI | 1164406153 |
---|---|
Provider Name | Mr. David Gozal |
First Address | Kansas City, MO 64184-3966 |
Second Address | Columbia, MO 65201-6626 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2005 |
Last Update Date | 22/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200258650 | (05) | IN |
F63113 | (02) | |
F63113 | (02) | KY |