MEDICARE: DR. DAVID F. OUELLETTE M.D.

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	R9F45	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093794588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID F. OUELLETTE M.D.

Provider Business Mailing Address
First Line	:	6500 HOSPITAL DR
Second Line	:	P.O. BOX 1239
City	:	HANNIBAL
State	:	MO
Zip	:	63401-6890
Country	:	US
Telephone Number	:	573-406-5888
Fax Number	:	573-248-5264

Provider Business Practice Location Address
First Line	:	400 S CENTER ST
Second Line	:
City	:	SHELBINA
State	:	MO
Zip	:	63468-1404
Country	:	US
Telephone Number	:	573-588-4131
Fax Number	:	573-588-4876

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

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	01/08/2016

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Directions to “ DR. DAVID F. OUELLETTE M.D.” Practice Location

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