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General NPI Number Information
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NPI Number | 1477552479
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Entity Type | Individual
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Provider Name | MICHAEL H LEDBETTER DO
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Gender | Male
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Dates
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Enumeration Date | 07/20/2005
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Last Update Date | 07/23/2009
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Provider Practice Location Address
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Address Line | 1930 N BUSINESS ROUTE 5 UNIT 1A
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City | CAMDENTON
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State | MO
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Zip | 65020-2659
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Country | US
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Telephone | 573-346-5624
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Fax | 573-346-1957
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Provider Business Mailing Address
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Address Line | 54 HOSPITAL DR
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City | OSAGE BEACH
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State | MO
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Zip | 65065-3050
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Country | US
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Telephone |
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Fax |
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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 | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | R9D86
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License Number State | MO
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