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General NPI Number Information
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NPI Number | 1699933838
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Entity Type | Organization
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Legal Business Name | LAKESIDE OBSTETRICS & GYNECOLOGY LLC
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Dates
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Enumeration Date | 05/23/2008
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Last Update Date | 11/10/2008
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Provider Practice Location Address
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Address Line | 980 PARKSIDE VILLAGE LN
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City | OSAGE BEACH
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State | MO
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Zip | 65065-3098
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Country | US
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Telephone | 573-302-1114
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Fax | 573-302-0077
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Provider Business Mailing Address
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Address Line | 980 PARKSIDE VILLAGE LN
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City | OSAGE BEACH
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State | MO
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Zip | 65065-3098
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Country | US
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Telephone | 573-302-1114
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Fax | 573-302-0077
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Authorized Official
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Title or Position | CO MANAGER
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Name | DR. KEVIN JAMES HOOKER
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Credential | MD
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Telephone | 573-302-1114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 2008006546
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License Number State | MO
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