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General NPI Number Information
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NPI Number | 1154650331
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Entity Type | Organization
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Legal Business Name | POPLAR BLUFF NEUROLOGY CENTER, PC
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Dates
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Enumeration Date | 12/16/2009
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Last Update Date | 03/11/2015
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Provider Practice Location Address
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Address Line | 2210 BARRON RD SUITE 112
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-1908
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Country | US
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Telephone | 573-785-0889
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Fax | 573-785-2011
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Provider Business Mailing Address
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Address Line | 2210 BARRON RD SUITE 112
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-1908
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Country | US
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Telephone | 573-785-0889
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Fax | 573-785-2011
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Authorized Official
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Title or Position | PRESEDENT
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Name | DR. SHAHID KARIM CHOUDHARY
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Credential | M.D.
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Telephone | 573-785-0889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 104541
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License Number State | MO
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