Provider Demographics
NPI:1205853082
Name:LIFE, DENNIS L (DPM)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:L
Last Name:LIFE
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:305 N KEENE ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6897
Mailing Address - Country:US
Mailing Address - Phone:573-449-5957
Mailing Address - Fax:573-449-5886
Practice Address - Street 1:305 N KEENE ST
Practice Address - Street 2:SUITE 209
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6897
Practice Address - Country:US
Practice Address - Phone:573-449-5957
Practice Address - Fax:573-449-5886
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO000404213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTT42867Medicare UPIN