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NPI Code Detail

MEDICARE: DR. DONALD KEITH WONDER II M.D.

MEDICARE: DR. DONALD KEITH WONDER II M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery PhysicianR1E13MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578511200
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DONALD KEITH WONDER II M.D.
Provider Business Mailing Address
First Line : PO BOX 3810
Second Line :
City : JOPLIN
State : MO
Zip : 64803-3810
Country : US
Telephone Number : 417-455-4200
Fax Number :
Provider Business Practice Location Address
First Line : 336 S JEFFERSON ST
Second Line :
City : NEOSHO
State : MO
Zip : 64850-1769
Country : US
Telephone Number : 417-455-4200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2006
Last Update Date : 05/09/2017

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