Healthcare Provider Details

I. General information

NPI: 1285751834
Provider Name (Legal Business Name): PERPETUA AKEYO OWUOR O.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 DOCTORS DR
FARMINGTON MO
63640-2932
US

IV. Provider business mailing address

904 S WASHINGTON ST
FARMINGTON MO
63640-1851
US

V. Phone/Fax

Practice location:
  • Phone: 573-756-2320
  • Fax: 573-760-8677
Mailing address:
  • Phone: 573-760-1053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number003471
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: