Provider Demographics
NPI:1487732368
Name:TEGTMEYER, VERNON C (MD)
Entity type:Individual
Prefix:DR
First Name:VERNON
Middle Name:C
Last Name:TEGTMEYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 2580
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-2580
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:417-829-4316
Practice Address - Street 1:120 HOSPITAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-9238
Practice Address - Country:US
Practice Address - Phone:417-533-6751
Practice Address - Fax:417-533-6755
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2008-07-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO36317207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202000535Medicaid
MO038013230Medicare PIN
MO319013268Medicare PIN
MOA11948Medicare UPIN