MEDICARE: DEANNA JUSTINE BAJALA 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	2019025551	MO

General Provider Information

NPI Number	:	1689038077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANNA JUSTINE BAJALA M.D.

Provider Business Mailing Address
First Line	:	1001 W WORLEY ST
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-2037
Country	:	US
Telephone Number	:	844-853-8937
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 W WORLEY ST
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-2037
Country	:	US
Telephone Number	:	844-853-8937
Fax Number	:

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

Provider Enumeration Date	:	04/11/2016
Last Update Date	:	04/14/2026

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