Executive Pulmonary Medicine, PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

2003009194 Issued in MO

Legal business name

EXECUTIVE PULMONARY MEDICINE, PC

Practice address

1906A Greenwood Dr
Poplar Bluff, MO 63901-2430

Phone

(573) 776-7740

Fax

(573) 776-7750

NPI assigned

Apr 7, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Dennis Daniels, MDNPI 1265404222

Title

Owner

Phone

(573) 776-7740

Specialties & licenses 1

Addresses

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dennis Edwards Daniels, MD

  • Pulmonary Disease Physician
  • Poplar Bluff, MO
  • NPI 1265404222
  Authorized official Same address or phone
• Poppy Daniels, MD

  • Obstetrics & Gynecology Physician
  • Ozark, MO
  • NPI 1952374332
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720041197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1087",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639021087",
            "telephone_number": "573-785-4601",
            "fax_number": "573-686-0178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1906A GREENWOOD DR",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639012430",
            "telephone_number": "573-776-7740",
            "fax_number": "573-776-7750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE PULMONARY MEDICINE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DANIELS",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "573-776-7740",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2003009194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Cody Eveland
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• Kathleen L Fain
• Clea Marie Fairaizl, LCSW
• Michael Scott Fairlamb

• Internal Medicine Physician in Poplar Bluff, MO
• Providers in Poplar Bluff, MO by specialty
• Internal Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.