Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 2018001015 | MO |
NPI | 1043566235 |
---|---|
Provider Name | Yezaz Ahmed Ghouri |
First Address | Kansas City, MO 64184-3966 |
Second Address | Columbia, MO 65212-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2012 |
Last Update Date | 20/11/2018 |