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General NPI Number Information
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NPI Number | 1093805251
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Entity Type | Individual
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Provider Name | MARK NEUENSCHWANDER
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Gender | Male
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12647 OLIVE BLVD SUITE 600
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City | SAINT LOUIS
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State | MO
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Zip | 63141-6345
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Country | US
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Telephone | 800-325-3982
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Fax |
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Provider Business Mailing Address
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Address Line | 5515 NW CACHE RD APT D4
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City | LAWTON
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State | OK
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Zip | 73505-3345
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Country | US
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Telephone | 580-458-2225
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 12565
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License Number State | OK
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