Healthcare Provider Details

I. General information

NPI: 1366497489
Provider Name (Legal Business Name): GEORGE R RADER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 WEST 32ND STREET
JOPLIN MO
64804
US

IV. Provider business mailing address

PO BOX 3810
JOPLIN MO
64803
US

V. Phone/Fax

Practice location:
  • Phone: 417-347-1078
  • Fax: 417-347-1079
Mailing address:
  • Phone: 417-347-1078
  • Fax: 417-347-1078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2000154587
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: