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General NPI Number Information
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NPI Number | 1073517900
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Entity Type | Individual
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Provider Name | MICHAEL PETER DUDENHOEFFER DO
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Gender | Male
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 606 E HIGH ST
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City | JEFFERSON CITY
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State | MO
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Zip | 65101-3279
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Country | US
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Telephone | 573-635-2211
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Fax | 573-636-9350
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Provider Business Mailing Address
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Address Line | 606 E HIGH ST
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City | JEFFERSON CITY
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State | MO
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Zip | 65101-3279
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Country | US
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Telephone | 573-635-2211
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Fax | 573-636-9350
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | R1F18
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License Number State | MO
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