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Individual

JOSE S PADILLA JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
120 HOSPITAL DR, SUITE 200, LEBANON, MO 65536-9238
(417) 533-6780
(417) 533-6789
Mailing address
PO BOX 505164, SAINT LOUIS, MO 63150-5164
(417) 829-4620
(417) 829-4316

Taxonomy

Speciality
Code
Description
License number
State
173000000X
Legal Medicine
N-8118
AR
208600000X
Surgery Physician
Primary
2015008157
MO
208600000X
Surgery Physician
N8118
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
120084001
AR
05
PENDING
MO
Enumeration date
08/01/2006
Last updated
07/31/2015
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