Organization
NEOSHO BONE & JOINT CLINIC P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH ALEN PETERSEN (MANAGER)
(417) 451-1833
Entity
Organization
Contact information
Practice address
4040 LAQUESTA DRIVE, NEOSHO, MO 64850-2849
(417) 451-1833
(417) 451-1825
Mailing address
4040 LAQUESTA DR., NEOSHO, MO 64850-2849
(417) 451-1833
(417) 451-1825
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
R9N57
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
246862114
—
MO
Enumeration date
11/20/2009
Last updated
11/20/2009
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