Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 14-03258 | KS |
Y | 213ES0000X | Sports Medicine | 14-03258 | KS |
NPI | 1083171409 |
---|---|
Provider Name | Mr. Luke Evan Snavely |
First Address | Joplin, MO 64801-7820 |
Second Address | Galena, KS 66739-4325 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2019 |
Last Update Date | 25/02/2019 |