Healthcare Provider Details

I. General information

NPI: 1184136558
Provider Name (Legal Business Name): CLIFFORD STRUPP MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2017
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 PROSPECT DR
MACON MO
63552-2615
US

IV. Provider business mailing address

1706 PROSPECT DR
MACON MO
63552-2615
US

V. Phone/Fax

Practice location:
  • Phone: 660-385-1006
  • Fax:
Mailing address:
  • Phone: 660-385-1006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number2017038041
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number2017038041
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2017038041
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2017038041
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: