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General NPI Number Information
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NPI Number | 1225173594
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Entity Type | Organization
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Legal Business Name | JEAN A.GILSTRAP,M.D., P.C.
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 06/19/2012
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Provider Practice Location Address
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Address Line | 20868 LYNWOOD RD
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City | WAYNESVILLE
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State | MO
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Zip | 65583-4602
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Country | US
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Telephone | 573-280-5884
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4418
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City | WAYNESVILLE
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State | MO
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Zip | 65583-4418
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Country | US
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Telephone | 573-280-5884
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEAN A. GILSTRAP
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Credential | M.D.
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Telephone | 573-280-5884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 107251
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License Number State | MO
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