Healthcare Provider Details

I. General information

NPI: 1033104005
Provider Name (Legal Business Name): JAMES S. DENNINGHOFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E BROADWAY SUITE 304
COLUMBIA MO
65201-8018
US

IV. Provider business mailing address

1701 E BROADWAY SUITE 304
COLUMBIA MO
65201-8018
US

V. Phone/Fax

Practice location:
  • Phone: 573-815-0662
  • Fax: 573-443-1162
Mailing address:
  • Phone: 573-815-0662
  • Fax: 573-443-1162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number36275
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: