Healthcare Provider Details

I. General information

NPI: 1326198573
Provider Name (Legal Business Name): DON OFFUT LMLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 N MILL ST STE 5
BELOIT KS
67420-2353
US

IV. Provider business mailing address

425 HOUSTON ST PO BOX 747
MANHATTAN KS
66502-6169
US

V. Phone/Fax

Practice location:
  • Phone: 785-738-5363
  • Fax:
Mailing address:
  • Phone: 785-587-4346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0103
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: