Doctor Name: | OCTAVE C MERVEILLE |
NPI Number: | 1245599976 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 33146 |
Business Practice Address: | 4201 S Hocker Dr Independence, MO - 640554723 |
Business Phone Number: | 9133840834 |
Business Fax Number: | |
Mailing Address: | 6500 Aberdeen Rd, MISSION HILLS |
State: | KS |
Postal Code: | 662081821 |
Phone Number: | 9133840834 |
Fax Number: | |
NPI Enumeration Date: | 05/15/2012 |
NPI Last Update Date: | 05/15/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 33146 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |