Healthcare Provider Details

I. General information

NPI: 1760590376
Provider Name (Legal Business Name): UROLOGY CONSULTANTS OF CENTRAL MISSOURI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 E BROADWAY SUITE 340
COLUMBIA MO
65201-7166
US

IV. Provider business mailing address

1705 E BROADWAY SUITE 340
COLUMBIA MO
65201-7166
US

V. Phone/Fax

Practice location:
  • Phone: 573-499-4990
  • Fax: 573-443-6294
Mailing address:
  • Phone: 573-499-4990
  • Fax: 573-443-6294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN DRESNER
Title or Position: CHAIRMAN OF THE BOARD
Credential: M.D.
Phone: 573-499-4990