1356385553 NPI number — DAVID H AFSHAR DO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356385553 NPI number — DAVID H AFSHAR DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AFSHAR
Provider First Name:
DAVID
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356385553
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
545 BRANSON LANDING BLVD
Provider Second Line Business Mailing Address:
SUITE 508
Provider Business Mailing Address City Name:
BRANSON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-335-7540
Provider Business Mailing Address Fax Number:
417-335-7544

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
545 BRANSON LANDING BLVD
Provider Second Line Business Practice Location Address:
SUITE 508
Provider Business Practice Location Address City Name:
BRANSON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-335-7528
Provider Business Practice Location Address Fax Number:
417-335-7588
Provider Enumeration Date:
06/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  36943 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P000174105 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 242685428 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 174076 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10914 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




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