Healthcare Provider Details

I. General information

NPI: 1669565552
Provider Name (Legal Business Name): JERRY DONALD HOWARD JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 01/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N KENTUCKY AVE
WEST PLAINS MO
65775-2029
US

IV. Provider business mailing address

26 DOGWOOD CIR
WEST PLAINS MO
65775-5171
US

V. Phone/Fax

Practice location:
  • Phone: 417-257-6713
  • Fax: 417-257-5878
Mailing address:
  • Phone: 417-256-4666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2006019828
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: