| Organization Name: | POPLAR BLUFF CANCER & RADIATION SPECIALIST LLC |
| NPI Number: | 1104963354 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SUBHASH GUJARATI (PHYSICIAN) |
| Mailing Address: | 2620 N Westwood Blvd Poplar Bluff |
| State: | MO US |
| Postal Code: | 639013396 |
| Phone Number: | 5736865300 |
| Fax Number: | |
| NPI Enumeration Date: | 01/30/2007 |
| NPI Last Update Date: | 05/24/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085R0203X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Therapeutic Radiology |
| Taxonomy Definition: | |