Individual
MRS. AMANDA W DETAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1130 E 32ND ST, JOPLIN, MO 64804-4034
(417) 347-2273
(417) 347-2277
Mailing address
PO BOX 3810, JOPLIN, MO 64803-3810
(417) 347-4662
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2008030163
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396944294
—
MO
Enumeration date
07/12/2007
Last updated
07/20/2023
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