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General NPI Number Information
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NPI Number | 1356599641
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Entity Type | Organization
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Legal Business Name | NEOSHO BONE & JOINT CLINIC P.C.
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Dates
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Enumeration Date | 08/29/2008
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Last Update Date | 08/29/2008
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Provider Practice Location Address
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Address Line | 4040 LAQUESTA DRIVE
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City | NEOSHO
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State | MO
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Zip | 64850
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Country | US
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Telephone | 417-451-1833
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Fax | 417-451-1825
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Provider Business Mailing Address
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Address Line | 4040 LAQUESTA DR.
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City | NEOSHO
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State | MO
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Zip | 64850
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Country | US
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Telephone | 417-451-1833
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Fax | 417-451-1825
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Authorized Official
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Title or Position | ORTHOPEDIC SURGEON
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Name | DR. HORACE REX PETERSEN
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Credential | D.O.
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Telephone | 417-451-1833
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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 | R9N57
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License Number State | MO
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