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General NPI Number Information
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NPI Number | 1013050970
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Entity Type | Organization
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Legal Business Name | CENTRAL MO EAR, NOSE, THROAT, & SINUS, P.C.
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 08/17/2022
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Provider Practice Location Address
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Address Line | 3527 W TRUMAN BLVD STE 200
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City | JEFFERSON CITY
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State | MO
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Zip | 65109-5902
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Country | US
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Telephone | 573-659-5570
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Fax | 573-659-5577
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Provider Business Mailing Address
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Address Line | 3527 W TRUMAN BLVD STE 200
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City | JEFFERSON CITY
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State | MO
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Zip | 65109-5902
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Country | US
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Telephone | 573-659-5570
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Fax | 573-659-5577
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT J MCDONALD
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Credential | MD
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Telephone | 573-659-5570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MDR1K87
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License Number State | MO
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