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General NPI Number Information
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NPI Number | 1104829282
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Entity Type | Individual
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Provider Name | SIDNEY ALLEN RHEA CANTRELL D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 12/05/2022
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Provider Practice Location Address
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Address Line | 2101 CORONA RD STE 102
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City | COLUMBIA
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State | MO
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Zip | 65203-2582
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Country | US
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Telephone | 573-234-1800
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Fax | 573-234-1799
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Provider Business Mailing Address
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Address Line | 2101 CORONA RD STE 102
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City | COLUMBIA
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State | MO
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Zip | 65203-2582
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Country | US
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Telephone | 573-234-1800
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Fax | 573-234-1799
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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 | R9D24
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License Number State | MO
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