Healthcare Provider Details

I. General information

NPI: 1578890257
Provider Name (Legal Business Name): GARRY ERSKINE FINKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2009
Last Update Date: 09/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1137 INDEPENDENCE DR
WEST PLAINS MO
65775-4221
US

IV. Provider business mailing address

1137 INDEPENDENCE DR
WEST PLAINS MO
65775-4221
US

V. Phone/Fax

Practice location:
  • Phone: 417-293-8464
  • Fax:
Mailing address:
  • Phone: 417-255-8464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2009031646
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: