Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 2005031309 | MO |
NPI | 1063474484 |
---|---|
Provider Name | Dr. Mary Margaret Wollmering |
First Address | Branson, MO 65615-0770 |
Second Address | Branson, MO 65616 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2006 |
Last Update Date | 26/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
206576 | BCBS (01) | |
250766 | HEALTHLINK (01) | |
G55481 | (02) | MO |
P00266172 | RAILROAD MEDICARE (01) |