Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 2016032791 | MO |
Y | 2080P0205X | Pediatric Endocrinologist | 2016032791 | MO |
NPI | 1336437078 |
---|---|
Provider Name | Rashmi Jain |
First Address | Springfield, MO 65804 |
Second Address | Springfield, MO 65804-2257 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2011 |
Last Update Date | 19/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PENDING | (05) | AR |
PENDING | (05) | MO |
PENDING | (05) | OK |
PENDING | MEDICARE (01) | MO |