Healthcare Provider Details

I. General information

NPI: 1659380186
Provider Name (Legal Business Name): RUANNE M STAMPS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 KEENE ST
COLUMBIA MO
65201-6626
US

IV. Provider business mailing address

910 N COLLEGE AVE STE 4
COLUMBIA MO
65201-4797
US

V. Phone/Fax

Practice location:
  • Phone: 573-875-9400
  • Fax: 573-884-5410
Mailing address:
  • Phone: 636-642-1215
  • Fax: 573-234-4799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number101363
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number101363
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: