Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 015302 | MO |
N | 204E00000X | Oral & Maxillofacial Surgeon | 2001004435 | MO |
NPI | 1023049285 |
---|---|
Provider Name | Randal Begley |
First Address | Cape Girardeau, MO 63703-4906 |
Second Address | Cape Girardeau, MO 63703-4927 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 15/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
408006518 | (05) | MO |
H45965 | (02) | MO |