Individual
CYSCO ALLEN MERISOTES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2115 S FREMONT AVE STE 5000, SPRINGFIELD, MO 65804-2230
(417) 820-3912
Mailing address
46 W CHERRY ST, FAIR GROVE, MO 65648-8433
(417) 849-1172
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
2025000589
MO
Other
Enumeration date
02/19/2025
Last updated
02/19/2025
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