# SEMO OTOLARYNGOLOGY HEAD & NECK SURGERY INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720095466
- **Authorized official:** TAMMY JEAN DEIMUND (OFFICE MANAGER)
- **Authorized official phone:** (573) 335-4448

## Contact information

- **Practice address:** 150 SOUTH MOUNT AUBURN ROAD, SUITE 420, CAPE GIRARDEAU, MO 63703
- **Practice address phone:** (573) 335-4448
- **Practice address fax:** (573) 335-4466
- **Mailing address:** 150 SOUTH MOUNT AUBURN ROAD, SUITE 420, CAPE GIRARDEAU, MO 63703
- **Mailing address phone:** (573) 335-4448
- **Mailing address fax:** (573) 335-4466

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Y00000X | Otolaryngology Physician | 2001021769 | MO | — |
| 207Y00000X | Otolaryngology Physician | MD108690 | MO | — |
| 207Y00000X | Otolaryngology Physician | R8494 | MO | Yes |

## Other

- **Enumeration date:** 08/02/2006
- **Last updated:** 08/22/2020