Healthcare Provider Details

I. General information

NPI: 1083686661
Provider Name (Legal Business Name): PHILIP L RUMBAOA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PHILIP RUMBAOA MD

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1241 W STADIUM BLVD
JEFFERSON CITY MO
65109-6023
US

IV. Provider business mailing address

1330 GRACE LN
BOONVILLE MO
65233-2146
US

V. Phone/Fax

Practice location:
  • Phone: 573-635-5264
  • Fax:
Mailing address:
  • Phone: 660-537-0285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0426821
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036115065
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2000163033
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number036115065
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number0426821
License Number StateKS
# 6
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number2000163033
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: