Healthcare Provider Details

I. General information

NPI: 1154520757
Provider Name (Legal Business Name): NATHAN SETH BOX D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2613 S MAIN ST STE D
JOPLIN MO
64804-2678
US

IV. Provider business mailing address

2613 S MAIN ST STE D
JOPLIN MO
64804-2678
US

V. Phone/Fax

Practice location:
  • Phone: 417-553-7920
  • Fax: 877-464-5922
Mailing address:
  • Phone: 417-553-7920
  • Fax: 877-464-5922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number2009032385
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number2009032385
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number2005019100
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: