MEDICARE: ANGELA J BRECKENRIDGE DO

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	207V00000X	Obstetrics & Gynecology Physician	2014028840	MO
2	207V00000X	Obstetrics & Gynecology Physician	OS22445	FL
3	207V00000X	Obstetrics & Gynecology Physician	38154	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2001	OTHER		INTERNAL ID-MOTOR VEHICLE ID

General Provider Information

NPI Number	:	1801976261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA J BRECKENRIDGE DO

Provider Business Mailing Address
First Line	:	54 HOSPITAL DR
Second Line	:
City	:	OSAGE BEACH
State	:	MO
Zip	:	65065-3050
Country	:	US
Telephone Number	:	573-302-2764
Fax Number	:	573-302-2767

Provider Business Practice Location Address
First Line	:	54 HOSPITAL DR
Second Line	:
City	:	OSAGE BEACH
State	:	MO
Zip	:	65065-3050
Country	:	US
Telephone Number	:	573-302-2764
Fax Number	:	573-302-2767

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	03/02/2026

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