Unknown Individual – Neurology Physician, NPI 1407945934

Unknown Individual is a healthcare provider. based in Cape girardeau, Missouri. specializing in Neurology Physician. They hold a License No. R7G30 (MO). The NPI Number for Unknown Individual is 1407945934

Main info

Organization
Inactive
67 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1407945934
Phone
(573) 331-7840
Address
1723 BROADWAY
Deactivation Date
22 January 2026

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5733344822
Graduation Year
1959 (67 years ago)
PAC ID
8729036686
Group Practice PAC ID
9133024334
Professional Enrollment ID
I20050311000051
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience19
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 1723, Broadway Street, Cape Girardeau, Cape Girardeau County, Missouri, 63701, United States

    SUITE 210

    CAPE GIRARDEAU, MO 63701

    Phone: (573) 331-7840

    Fax: (573) 331-7849

    Type: Location

  • Ashland Hills Estates, Cape Girardeau, Cape Girardeau County, Missouri, United States

    CAPE GIRARDEAU, MO 637012167

    Phone:

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 63701)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 9133024334View full group profile
NameSpecialtyState
A N E S T H E S I O L O G YKY
Registered Dietitian Or Nutrition ProfessionalMO
Nurse PractitionerMO
-MO
Certified Registered Nurse Anesthetist (Crna)MO
Nurse PractitionerMO
-MO
Certified Registered Nurse Anesthetist (Crna)IL
-MO
O B S T E T R I C S/ G Y N E C O L O G YAR

Reviews

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Frequently asked questions

What NPI should I save for Unknown Individual?
Save NPI 1407945934 if you need a stable reference for Unknown Individual.
How do I interpret inactive records for Unknown Individual?
Treat inactive as a signal to verify Unknown Individual through official channels.
What field does Unknown Individual work in?
You can think of Unknown Individual as practicing within Neurology Physician. Clinical services aligned with this taxonomy classification.
Does Unknown Individual practice in Missouri?
You will see Cape Girardeau, Missouri on file for Unknown Individual alongside any extra practice locations.
Is Unknown Individual a real provider?
This page reflects official NPPES data for NPI 1407945934. Always confirm identity and privileges with the practice and licensing boards.

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