Unknown Individual – Family Medicine Physician, NPI 1073587168
Family Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Unknown Individual
504 NW 10TH AVE.
AVA, MO 656081359
Phone: (417) 683-4831
Fax: (417) 683-1602
Type: Location
Avenida, Rua Sete de Setembro, Centro, Ponta Porã, Região Geográfica Imediata de Ponta Porã, Região Geográfica Intermediária de Dourados, Mato Grosso do Sul, Central-West Region, 79000-000, Brazil
AVA, MO 656081359
Phone: (417) 683-4831
Fax: (417) 683-1602
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 65608)
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