Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 015997 | MO |
NPI | 1104887439 |
---|---|
Provider Name | Perrin Saville Jungbluth |
First Address | Saint Joseph, MO 64506-3166 |
Second Address | Saint Joseph, MO 64506-2911 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 08/07/2007 |