Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 2004012270 | MO |
NPI | 1023067261 |
---|---|
Provider Name | Paul James Tolentino |
First Address | Cape Girardeau, MO 63702-1329 |
Second Address | Cape Girardeau, MO 63701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I17438 | (02) | MO |