Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1023500329 |
---|---|
Provider Name | Mr. Josh Allen |
First Address | West Plains, MO 65775-3854 |
Second Address | West Plains, MO 65775-3854 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2018 |
Last Update Date | 01/06/2018 |