Basic Information
| Provider Information | |||||||||
| NPI: | 1356385553 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AFSHAR | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 545 BRANSON LANDING BLVD | ||||||||
| Address2: | SUITE 508 | ||||||||
| City: | BRANSON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 65616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4173357540 | ||||||||
| FaxNumber: | 4173357544 | ||||||||
| Practice Location | |||||||||
| Address1: | 545 BRANSON LANDING BLVD | ||||||||
| Address2: | SUITE 508 | ||||||||
| City: | BRANSON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 65616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4173357528 | ||||||||
| FaxNumber: | 4173357588 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 11/18/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 36943 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | P000174105 | 01 | RAILROAD MEDICARE | OTHER | 242685428 | 05 | MO | MEDICAID | 174076 | 01 | HEALTHLINK | OTHER | 10914 | 01 | BCBS | OTHER |