Healthcare Provider Details

I. General information

NPI: 1730539974
Provider Name (Legal Business Name): TALON MANINGAS D.O. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2016
Last Update Date: 06/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 W 32ND ST STE B
JOPLIN MO
64804-2528
US

IV. Provider business mailing address

620 W 32ND ST STE B
JOPLIN MO
64804-2528
US

V. Phone/Fax

Practice location:
  • Phone: 417-437-0303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number2012005133
License Number StateMO

VIII. Authorized Official

Name: TALON MANINGAS
Title or Position: MEMBER
Credential:
Phone: 417-540-7880