Individual
IVAN EUGENE MILTON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
AT
Contact information
Practice address
901 S NATIONAL AVE, SPRINGFIELD, MO 65804-0027
(417) 836-5461
(417) 836-6101
Mailing address
1250 E STONEBROOK RD, OZARK, MO 65721-6275
(417) 581-8379
(417) 836-6101
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
00011
MO
Other
Enumeration date
08/02/2005
Last updated
07/08/2007
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