Individual
JAY NASTAV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1205 N MISSOURI ST, MACON, MO 63552-2095
(660) 385-8718
(660) 385-8711
Mailing address
1205 N MISSOURI ST, MACON, MO 63552-2095
(660) 385-8718
(660) 385-8711
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
2011005779
MO
208600000X
Surgery Physician
Primary
2011005779
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2011005779
MISSOURI LICENSE
MO
Enumeration date
08/29/2011
Last updated
12/11/2015
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