| Iron Bridge Diabetes & Endo | |
|
1135 E Lakewood St Suite 104 Springfield MO 65810-2403 | |
| (417) 879-6364 | |
| (417) 879-6368 |
| Full Name | Iron Bridge Diabetes & Endo |
|---|---|
| Speciality | Internal Medicine - Endocrinology, Diabetes & Metabolism |
| Location | 1135 E Lakewood St, Springfield, Missouri |
| Authorized Official Name and Position | Ralph J Duda (OWNER) |
| Authorized Official Contact | 4178796364 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Iron Bridge Diabetes & Endo 1135 E Lakewood St Suite 104 Springfield MO 65810-2403 Ph: (417) 879-6364 | Iron Bridge Diabetes & Endo 1135 E Lakewood St Suite 104 Springfield MO 65810-2403 Ph: (417) 879-6364 |
| NPI Number | 1306931423 |
|---|---|
| Provider Enumeration Date | 10/04/2006 |
| Last Update Date | 07/17/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306931423 | NPI | - | NPPES |
| 16610 | Other | BLUE CROSS BLUE SHIELD | |
| 460002667 | Other | PTAN | |
| P00266673 | Other | MO | RAILROAD MEDICARE PTAN |
| 000015170 | Other | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | (* (Not Available)) | Primary |
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