Liesen, James G

Liesen, James G is an individual health care provider with primary practice located at 1195 N Oakland Ave Suite 2, Bolivar MO 65613-8095. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Liesen, James G can be contacted via phone (417) 777-2121.

Contact Information

Primary practice address
1195 N Oakland Ave Suite 2 Bolivar MO 65613-8095
Phone: (417) 777-2121
Fax: (417) 777-2854
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 2101 West Virginia
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 2008032320 Missouri

Profile Details

NPI number 1003815291
LBN Legal business name Liesen, James G
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 19th, 2005
Last updated Feb 23rd, 2017 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1003815291 NPPES
West Virginia MEDICAID 3810002037

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