Healthcare Provider Details

I. General information

NPI: 1174878409
Provider Name (Legal Business Name): AMY O PUDERBAUGH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. AMY O APODACA

II. Dates (important events)

Enumeration Date: 07/24/2012
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3071 S GRAND AVE
CARTHAGE MO
64836-7851
US

IV. Provider business mailing address

3071 S GRAND AVE
CARTHAGE MO
64836-7851
US

V. Phone/Fax

Practice location:
  • Phone: 417-310-9286
  • Fax: 417-674-4662
Mailing address:
  • Phone: 417-310-9286
  • Fax: 417-674-4662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0102203730
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2015010237
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2015010237
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: