Search › Missouri › 101YP2500X
Jonathan Distaulo, PLPC
NPI 1801300637 · on the registry since 2017
Practice
- Address
- 3101c S Kimbrough Ave
Springfield, MO 65807 - Phone
- (417) 866-7773
- Clinicians at this address
- 3
Registry record
- Primary taxonomy
- 101YP2500X
101YP2500X
- Licence states on file
- MO
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2017-12-01
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Missouri