| Larry Deffenbaugh, Do,pc | |
|
1905 W. 32nd St. Suite 302 Joplin MO 64804 | |
| (417) 782-4701 | |
| (417) 624-5881 |
| Full Name | Larry Deffenbaugh, Do,pc |
|---|---|
| Speciality | Internal Medicine - Gastroenterology |
| Location | 1905 W. 32nd St. Suite 302, Joplin, Missouri |
| Authorized Official Name and Position | Larry D Deffenbaugh (PRESIDENT) |
| Authorized Official Contact | 4177824701 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Larry Deffenbaugh, Do,pc 1905 W. 32nd St. Suite 302 Joplin MO 64804 Ph: (417) 782-4701 | Larry Deffenbaugh, Do,pc 1905 W. 32nd St. Suite 302 Joplin MO 64804 Ph: (417) 782-4701 |
| NPI Number | 1760705925 |
|---|---|
| Provider Enumeration Date | 03/02/2010 |
| Last Update Date | 03/11/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760705925 | NPI | - | NPPES |
| 240076414 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | R6321 (Missouri) | Primary |
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