Provider Demographics
NPI:1043510019
Name:ANTHONY, DAVID GEORGE
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:GEORGE
Last Name:ANTHONY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 W 26TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-0394
Mailing Address - Country:US
Mailing Address - Phone:417-392-0816
Mailing Address - Fax:
Practice Address - Street 1:1617 W 26TH ST STE B
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-0394
Practice Address - Country:US
Practice Address - Phone:417-392-0816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006190231H00000X
MO2011039545231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist