Provider Demographics
NPI:1861409625
Name:MAIN, DONET CHRISTOPHER (DO)
Entity type:Individual
Prefix:
First Name:DONET
Middle Name:CHRISTOPHER
Last Name:MAIN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:PO BOX 402
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:MO
Mailing Address - Zip Code:63552-0402
Mailing Address - Country:US
Mailing Address - Phone:660-385-1008
Mailing Address - Fax:660-385-1062
Practice Address - Street 1:1706 PROSPECT DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MO
Practice Address - Zip Code:63552-2615
Practice Address - Country:US
Practice Address - Phone:660-385-1006
Practice Address - Fax:660-385-1028
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO110583208VP0014X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200041474OtherRR MEDICARE