Individual
DR. SOSTANIE TAKOTA ENORU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3501 W TRUMAN BLVD # A, JEFFERSON CITY, MO 65109-0514
(573) 636-0635
Mailing address
PO BOX 363, JEFFERSON CITY, MO 65102-0363
(573) 636-0635
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
292675
NY
207RC0000X
Cardiovascular Disease Physician
Primary
2022031212
MO
207RC0000X
Cardiovascular Disease Physician
292675
NY
207RI0011X
Interventional Cardiology Physician
2022031212
MO
208M00000X
Hospitalist Physician
292675
NY
390200000X
Student in an Organized Health Care Education/Training Program
292675
NY
Other
Enumeration date
02/05/2015
Last updated
08/08/2022
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