Healthcare Provider Details

I. General information

NPI: 1205885324
Provider Name (Legal Business Name): COLUMBIA GASTROENTEROLOGY & LIVER ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 E BROADWAY SUITE 250
COLUMBIA MO
65201-8023
US

IV. Provider business mailing address

1605 E BROADWAY STE 250
COLUMBIA MO
65201-8023
US

V. Phone/Fax

Practice location:
  • Phone: 573-449-8680
  • Fax: 573-449-8684
Mailing address:
  • Phone: 573-449-8680
  • Fax: 573-449-8684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL D. KING
Title or Position: PHYSICIAN
Credential: MD
Phone: 573-449-8680