Healthcare Provider Details

I. General information

NPI: 1518915214
Provider Name (Legal Business Name): LYNN L. KLEOPFER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PORTLAND ST STE 110
COLUMBIA MO
65201-7390
US

IV. Provider business mailing address

300 PORTLAND ST STE 110
COLUMBIA MO
65201-7390
US

V. Phone/Fax

Practice location:
  • Phone: 573-886-4600
  • Fax: 573-886-4695
Mailing address:
  • Phone: 573-886-4600
  • Fax: 573-886-4695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberR7C43
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMDR7C43
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: