Organization
POPLAR BLUFF CANCER & RADIATION SPECIALIST LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUBHASH GUJARATI M.D. (PHYSICIAN)
(573) 686-5300
Entity
Organization
Contact information
Practice address
2620 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-3396
(573) 686-5300
Mailing address
PO BOX 958262, SAINT LOUIS, MO 63195-8262
(636) 207-0537
(636) 207-0221
Taxonomy
Speciality
Code
Description
License number
State
2085R0203X
Therapeutic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
711887000
—
MO
Enumeration date
01/30/2007
Last updated
05/24/2010
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