MEDICARE: JEREMY D MABE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	2000154576	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	080174333	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	14189	OTHER	COX HEALTH SYSTEMS
4	144172	OTHER	BCBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	462206	OTHER	HEALTHLINK

General Provider Information

NPI Number	:	1053355206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY D MABE MD

Provider Business Mailing Address
First Line	:	1150 STATE HIGHWAY 248
Second Line	:	STE. 202
City	:	BRANSON
State	:	MO
Zip	:	65616-3758
Country	:	US
Telephone Number	:	417-348-8964
Fax Number	:	417-336-0275

Provider Business Practice Location Address
First Line	:	1150 STATE HIGHWAY 248
Second Line	:	STE. 202
City	:	BRANSON
State	:	MO
Zip	:	65616-3758
Country	:	US
Telephone Number	:	417-348-8964
Fax Number	:	417-336-0275

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	03/24/2014

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Directions to “ JEREMY D MABE MD” Practice Location

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