Individual
DR. MANUEL LE-YENG SAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2101 CORONA RD STE 102, COLUMBIA, MO 65203-2582
(573) 234-1800
(573) 234-1799
Mailing address
2101 CORONA RD STE 102, COLUMBIA, MO 65203-2582
(573) 234-1800
(573) 234-1799
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2006029319
MO
207QG0300X
Geriatric Medicine (Family Medicine) Physician
2006029319
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1245443548
—
MO
05
—
207024605
—
MO
01
—
P00770996
RR MEDICARE PTAN
MO
Enumeration date
05/07/2007
Last updated
07/21/2023
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