Healthcare Provider Details

I. General information

NPI: 1730167164
Provider Name (Legal Business Name): FREDERICK MICHAEL SCHEKORRA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 06/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 KIDWELL CAPITAL REGION MEDICAL CLINIC VERSAILLES
VERSAILLES MO
65084
US

IV. Provider business mailing address

901 KIDWELL CAPITAL REGION MEDICAL CLINIC VERSAILLES
VERSAILLES MO
65084
US

V. Phone/Fax

Practice location:
  • Phone: 573-378-4666
  • Fax: 573-378-5099
Mailing address:
  • Phone: 573-378-4666
  • Fax: 573-378-5099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR7J23
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: