Healthcare Provider Details

I. General information

NPI: 1720283450
Provider Name (Legal Business Name): GRETCHEN ELIZABETH FARMER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRETCHEN ELIZABETH KLUESNER MD

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 PRAIRIE DELL RD STE 400
UNION MO
63084-4327
US

IV. Provider business mailing address

1935 PRAIRIE DELL RD STE 400
UNION MO
63084-4327
US

V. Phone/Fax

Practice location:
  • Phone: 636-649-3085
  • Fax: 636-649-3087
Mailing address:
  • Phone: 636-649-3085
  • Fax: 636-649-3086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2007005528
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2007005528
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: