Healthcare Provider Details

I. General information

NPI: 1689985392
Provider Name (Legal Business Name): CHAD THOMAS AGNEW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 07/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 SKAGGS RD
BRANSON MO
65616-2031
US

IV. Provider business mailing address

PO BOX 1308
BRANSON MO
65615-1308
US

V. Phone/Fax

Practice location:
  • Phone: 417-239-3392
  • Fax:
Mailing address:
  • Phone: 417-239-3392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2014018771
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: