Provider Demographics
NPI:1780682880
Name:PACHECO-GIL, JOSE M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:M
Last Name:PACHECO-GIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2787
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-2787
Mailing Address - Country:US
Mailing Address - Phone:417-499-5156
Mailing Address - Fax:417-206-4303
Practice Address - Street 1:100 MERCY WAY
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4524
Practice Address - Country:US
Practice Address - Phone:417-556-4462
Practice Address - Fax:417-556-2993
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR77652085R0001X
KS04-247212085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201776531Medicaid
OK100175990AMedicaid
MO920002777OtherRAILROAD MEDICARE
KS100116620BMedicaid
MO005011719Medicare PIN
D91161Medicare UPIN