Healthcare Provider Details

I. General information

NPI: 1508925553
Provider Name (Legal Business Name): MEYYAPPAN PALANIAPPAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 PLUM ST
DONIPHAN MO
63935-1277
US

IV. Provider business mailing address

39 OXEN PASTURE RD
DONIPHAN MO
63935-9453
US

V. Phone/Fax

Practice location:
  • Phone: 573-996-2141
  • Fax: 573-996-3949
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number114784
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: