Retired
NPI #1962818435 in Hallsville, Missouri
Provider Information
- NPI Number
- 1962818435
- Entity Type
- Organization
- Organization Name
- Retired
- Primary Specialty
- Clinic/Center - Medical Specialty
- Enumeration Date
- Jul 6, 2014
- Last Updated
- Jul 6, 2014
Practice Location
- Address
- 13714 N SPORTSMANS DR
- City
- Hallsville
- State
- Missouri
- ZIP Code
- 65255-9330
- Phone
- (573) 696-2391
Authorized Official
- Name
- HERB BASTOW, M.D.
- Title
- UROLOGIST
- Phone
- (573) 696-2391
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Medical Specialty — Medical Specialty |
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