Healthcare Provider Details

I. General information

NPI: 1245237403
Provider Name (Legal Business Name): WASIF F.M. ALMUTTAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2005
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 S MAIN ST
MARYVILLE MO
64468-2655
US

IV. Provider business mailing address

2016 S MAIN ST
MARYVILLE MO
64468-2655
US

V. Phone/Fax

Practice location:
  • Phone: 660-562-2573
  • Fax:
Mailing address:
  • Phone: 660-562-2573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberR9276
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: