Organization
SOUTHERN MISSOURI INTERNAL MEDICINE, PC
Active
Organization
SOUTHERN MISSOURI INTERNAL MEDICINE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK JEFFERY MCNABB D.O. (OWNER)
(573) 335-5057
Entity
Organization
Contact information
Practice address
3260 LEXINGTON AVE, CAPE GIRARDEAU, MO 63701-2609
(573) 335-5057
(573) 335-1552
Mailing address
3260 LEXINGTON AVE, CAPE GIRARDEAU, MO 63701-2609
(573) 335-5057
(573) 335-1552
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
DO100129
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203716006
—
MO
Enumeration date
11/15/2012
Last updated
11/15/2012
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