Individual
JAMES G LIESEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1195 N OAKLAND AVE, SUITE 2, BOLIVAR, MO 65613-8095
(417) 777-2121
(417) 777-2854
Mailing address
1500 N OAKLAND AVE, BOLIVAR, MO 65613-3011
(417) 328-6501
(417) 328-6338
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2008032320
MO
208000000X
Pediatrics Physician
2101
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810002037
—
WV
Enumeration date
07/19/2005
Last updated
02/23/2017
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