NPI 1003815291

James G Liesen, DO

Practitioner Pediatrics Physician Bolivar, MO

Practice location

Address: 1195 N Oakland Ave Suite 2, Bolivar, MO 65613-8095
Phone: (417) 777-2121
Fax: (417) 777-2854
Mailing address: 1500 N Oakland Ave, Bolivar, MO 65613-3011

Registered specialties (2)

Pediatrics Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 208000000X Licence 2008032320 (MO)

Other Pediatrics providers in Missouri →

Pediatrics Physician

Allopathic & Osteopathic Physicians Taxonomy 208000000X Licence 2101 (WV)

Registry record

NPI: 1003815291
Entity type: Individual
Sex (as registered): Male
NPI issued: 19 Jul 2005
Record last updated: 23 Feb 2017

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.