Individual
MR. CLAYTON REECE BURGOON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RRA
Contact information
Practice address
1 HOSPITAL DR, COLUMBIA, MO 65201-5276
(573) 882-4141
Mailing address
4104 CITATION DR, COLUMBIA, MO 65202-4514
Taxonomy
Speciality
Code
Description
License number
State
243U00000X
Radiology Practitioner Assistant
Primary
MRA02000029
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NA
—
Enumeration date
07/22/2021
Last updated
07/22/2021
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