Healthcare Provider Details

I. General information

NPI: 1245799154
Provider Name (Legal Business Name): STEPHEN HENRY LUEBBERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR # DC046.00
COLUMBIA MO
65201-5276
US

IV. Provider business mailing address

1 HOSPITAL DR # DC046.00
COLUMBIA MO
65201-5276
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-0406
  • Fax: 573-884-4540
Mailing address:
  • Phone: 573-882-0406
  • Fax: 573-884-4540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number1067
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number15307
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: