Healthcare Provider Details

I. General information

NPI: 1558776229
Provider Name (Legal Business Name): SHAWN STRANCKMEYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2014
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5383 E PLEASANT VALLEY LN
SPRINGFIELD MO
65809-3175
US

IV. Provider business mailing address

5383 E PLEASANT VALLEY LN
SPRINGFIELD MO
65809-3175
US

V. Phone/Fax

Practice location:
  • Phone: 314-540-9894
  • Fax:
Mailing address:
  • Phone: 314-540-9894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2014019429
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number1558776229
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: