Individual
SALVADOR CENICEROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
618 N BENTON AVE, SPRINGFIELD, MO 65806-1102
(417) 851-1563
(417) 831-8033
Mailing address
440 E TAMPA ST, SPRINGFIELD, MO 65806-1131
(417) 831-0150
(417) 831-8033
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
01052420A
IN
2084P0800X
Psychiatry Physician
Primary
2010006881
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457301129
—
MO
01
—
2010006881
STATE LICENSE
MO
05
—
204132302
—
MO
01
—
P01038084
RAILROAD MEDICARE
MO
Enumeration date
05/11/2006
Last updated
10/29/2018
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