Individual
CHANCE MERTGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1728 JESSE JAMES CT, BOONVILLE, MO 65233-2874
(573) 540-7160
Mailing address
1728 JESSE JAMES CT, BOONVILLE, MO 65233-2874
(573) 540-7160
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
S081081006
MO
Other
Enumeration date
12/01/2023
Last updated
12/01/2023
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