Healthcare Provider Details

I. General information

NPI: 1457856049
Provider Name (Legal Business Name): JEFFREY R DORHAUER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 HOSPITAL DR
OSAGE BEACH MO
65065-3050
US

IV. Provider business mailing address

6369 PELICAN DR
OSAGE BEACH MO
65065-5102
US

V. Phone/Fax

Practice location:
  • Phone: 573-302-2287
  • Fax: 573-302-2241
Mailing address:
  • Phone: 573-286-2406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2021032028
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: