Provider Demographics
NPI:1154454916
Name:MCINTIRE, PHILIP S (DO)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:S
Last Name:MCINTIRE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 W JEFFERSON ST
Mailing Address - Street 2:2ND FLOOR GUTENSOHN CLINIC
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-1443
Mailing Address - Country:US
Mailing Address - Phone:660-665-4432
Mailing Address - Fax:660-956-4392
Practice Address - Street 1:800 W JEFFERSON ST
Practice Address - Street 2:2ND FLOOR GUTENSOHN CLINIC
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-1443
Practice Address - Country:US
Practice Address - Phone:660-665-4432
Practice Address - Fax:660-956-4392
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR5E68208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO242064517Medicaid
MO242064517Medicaid