Healthcare Provider Details

I. General information

NPI: 1558371781
Provider Name (Legal Business Name): BETH ANN SJOBLOM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 636-642-1215
  • Fax: 573-234-4799
Mailing address:
  • Phone: 573-289-2656
  • Fax: 573-234-4799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number261788
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2003014835
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: