Healthcare Provider Details

I. General information

NPI: 1235798034
Provider Name (Legal Business Name): JUSTIN STEWART EHRHARDT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E 5TH ST
FULTON MO
65251-1793
US

IV. Provider business mailing address

1 HOSPITAL DR
COLUMBIA MO
65212-1000
US

V. Phone/Fax

Practice location:
  • Phone: 573-592-4100
  • Fax:
Mailing address:
  • Phone: 573-882-8907
  • Fax: 573-884-1070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2019018909
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: