Individual
ABRAHAM N AZAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
667 E 15TH ST, SEDALIA, MO 65301-7656
(660) 827-2525
Mailing address
601 E 14TH ST, PO BOX 1706, SEDALIA, MO 65301-5972
(866) 678-5627
(660) 827-3742
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
RA490
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08571025
BLUE CROSS BLUE SHIELD
MO
01
—
160059401
PALMETTO GBA
MO
05
—
201280427
—
MO
Enumeration date
06/28/2005
Last updated
06/09/2014
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