Healthcare Provider Details

I. General information

NPI: 1811330806
Provider Name (Legal Business Name): CORY L.S. OFFUTT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 OZARK DR STE B
CUBA MO
65453-1664
US

IV. Provider business mailing address

PO BOX 959318
SAINT LOUIS MO
63195-9318
US

V. Phone/Fax

Practice location:
  • Phone: 573-885-6600
  • Fax: 573-885-6610
Mailing address:
  • Phone: 573-885-6600
  • Fax: 573-885-6610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2015002436
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: