Organization
TADURAN SPORTS MEDICINE AND OSTEOPATHIC WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TROY VIRGIL MAYPA TADURAN D.O. (OWNER)
(620) 624-2565
Entity
Organization
Contact information
Practice address
102 E 11TH ST, LIBERAL, KS 67901-2784
(620) 624-2565
Mailing address
102 E 11TH ST, LIBERAL, KS 67901-2784
(620) 624-2565
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
05-34185
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05-34185
LICENSE
KS
01
—
OS 9896
LICENSE
FL
Enumeration date
03/17/2010
Last updated
03/17/2010
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