Deeken, Mary

Deeken, Mary is an individual health care provider with primary practice located at 3348 American Ave , Jefferson City MO 65109-1079. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Deeken, Mary can be contacted via phone (573) 761-7210.

Contact Information

Primary practice address
3348 American Ave Jefferson City MO 65109-1079
Phone: (573) 761-7210
Fax: (573) 634-8802
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 106715 Missouri

Profile Details

NPI number 1912937798
LBN Legal business name Deeken, Mary
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 4th, 2006
Last updated Sep 20th, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1912937798 NPPES
Missouri MEDICAID 203845300

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