Provider Demographics
NPI:1174878409
Name:PUDERBAUGH, AMY O (DO)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:O
Last Name:PUDERBAUGH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:O
Other - Last Name:APODACA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3071 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-7851
Mailing Address - Country:US
Mailing Address - Phone:417-310-9286
Mailing Address - Fax:417-674-4662
Practice Address - Street 1:3071 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-7851
Practice Address - Country:US
Practice Address - Phone:417-310-9286
Practice Address - Fax:417-674-4662
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102203730208D00000X
MO2015010237208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist