Organization
LARRY DEFFENBAUGH, DO,PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY D DEFFENBAUGH DO (PRESIDENT)
(417) 782-4701
Entity
Organization
Contact information
Practice address
1905 W. 32ND ST. SUITE 302, JOPLIN, MO 64804
(417) 782-4701
(417) 624-5881
Mailing address
1905 W. 32ND ST. SUITE 302, JOPLIN, MO 64804
(417) 782-4701
(417) 624-5881
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
R6321
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
240076414
—
MO
Enumeration date
03/02/2010
Last updated
03/11/2010
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