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General NPI Number Information
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NPI Number | 1326023185
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Entity Type | Individual
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Provider Name | PEGGY WANNER-BARJENBRUCH MD
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Gender | Female
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Dates
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Enumeration Date | 12/14/2005
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Last Update Date | 10/28/2022
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Provider Practice Location Address
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Address Line | 600 MEDICAL PARK DR
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City | MEXICO
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State | MO
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Zip | 65265-3724
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Country | US
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Telephone | 573-581-8500
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Fax | 573-581-5397
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Provider Business Mailing Address
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Address Line | 600 MEDICAL PARK DR
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City | MEXICO
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State | MO
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Zip | 65265-3724
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Country | US
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Telephone | 573-581-1040
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Fax | 573-581-5397
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | R2F18
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License Number State | MO
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