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General NPI Number Information
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NPI Number | 1457535288
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Entity Type | Organization
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Legal Business Name | WASIF ALMUTTAR,MD,ANES.SVC.,P.C.
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Dates
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Enumeration Date | 12/28/2007
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Last Update Date | 12/28/2007
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Provider Practice Location Address
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Address Line | 2016 S MAIN ST
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City | MARYVILLE
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State | MO
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Zip | 64468-2655
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Country | US
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Telephone | 660-562-2573
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 385
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City | MARYVILLE
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State | MO
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Zip | 64468-0385
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | WASIF FM ALMUTTAR
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Credential | MD
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Telephone | 660-562-2573
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | R9276
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License Number State | MO
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