Healthcare Provider Details

I. General information

NPI: 1689744781
Provider Name (Legal Business Name): MEDICAL DEVELOPMENTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 04/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 S NATIONAL AVE SUITE #110
SPRINGFIELD MO
65807-5209
US

IV. Provider business mailing address

3800 S NATIONAL AVE SUITE #110
SPRINGFIELD MO
65807-5209
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-5988
  • Fax: 417-269-5986
Mailing address:
  • Phone: 417-269-5988
  • Fax: 417-269-5986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number005537
License Number StateMO

VIII. Authorized Official

Name: JEFF HAWKINS
Title or Position: PRESIDENT
Credential:
Phone: 417-269-6263