MEDICARE: SHAWN STRANCKMEYER 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	2014019429	MO
2	207QA0401X	Addiction Medicine (Family Medicine) Physician	1558776229	MO

General Provider Information

NPI Number	:	1558776229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN STRANCKMEYER MD

Provider Business Mailing Address
First Line	:	5383 E PLEASANT VALLEY LN
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65809-3175
Country	:	US
Telephone Number	:	314-540-9894
Fax Number	:

Provider Business Practice Location Address
First Line	:	5383 E PLEASANT VALLEY LN
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65809-3175
Country	:	US
Telephone Number	:	314-540-9894
Fax Number	:

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

Provider Enumeration Date	:	06/21/2014
Last Update Date	:	07/13/2022

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