Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 16550 | KS |
NPI | 1023027281 |
---|---|
Provider Name | Walter S. Trombold |
First Address | Springfield, MO 65808-9007 |
Second Address | Springfield, MO 65807-5292 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 27/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1023027281 | (05) | MO |
202938502 | (05) | MO |