Provider Demographics
NPI:1578749024
Name:REGIONAL PLASTIC & RECONSTRUCTIVE
Entity Type:Organization
Organization Name:REGIONAL PLASTIC & RECONSTRUCTIVE
Other - Org Name:DUANE W SHERROD, M.D.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONJA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:WOODCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-782-3100
Mailing Address - Street 1:520 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-3904
Mailing Address - Country:US
Mailing Address - Phone:417-782-3100
Mailing Address - Fax:417-782-2342
Practice Address - Street 1:520 E 32ND ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3904
Practice Address - Country:US
Practice Address - Phone:417-782-3100
Practice Address - Fax:417-782-2342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7D97174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOCN5879OtherMEDICARE RAILROAD PIN
MO1982668125OtherNATIONAL PROVIDER IDENTIF
MO1982668125OtherNATIONAL PROVIDER IDENTIF
MO001012772Medicare PIN