Healthcare Provider Details

I. General information

NPI: 1063418879
Provider Name (Legal Business Name): DAVID B HUANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

985 EXECUTIVE DRIVE
OSAGE BEACH MO
65065
US

IV. Provider business mailing address

985 EXECUTIVE DR
OSAGE BEACH MO
65065-3496
US

V. Phone/Fax

Practice location:
  • Phone: 573-348-4863
  • Fax: 573-348-4863
Mailing address:
  • Phone: 573-348-4863
  • Fax: 573-348-4863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number109950
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: