Individual
PHILLIP W PITNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
211 S 3RD ST, LOUISIANA, MO 63353-2000
(573) 754-5555
(573) 754-4077
Mailing address
211 S 3RD ST, LOUISIANA, MO 63353-2000
(573) 754-5555
(573) 754-4077
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34602
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200558906
—
MO
05
—
200558948
—
MO
Enumeration date
07/29/2005
Last updated
03/07/2019
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