IRON BRIDGE DIABETES & ENDO (NPI# 1306931423) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306931423 |
| Entity Type | Organization |
| Organization Name | IRON BRIDGE DIABETES & ENDO |
| Practice Address |
1135 E Lakewood St Suite 104 Springfield MO 65810-2403 |
| Practice Telephone | 4178796364 |
| Practice Fax Number | 4178796368 |
| Mailing Telephone | 4178796364 |
| Mailing Fax Number | 4178796368 |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2008-07-17 |
| Authorized Official Name | DR. RALPH J DUDA JR. (OWNER) |
| Authorized Official Telephone | 4178796364 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RE0101X |
Internal Medicine Specialization: Endocrinology, Diabetes & Metabolism |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MEDICARE PTAN | 000015170 | 01 | |
| BLUE CROSS BLUE SHIELD | 16610 | 01 | |
| PTAN | 460002667 | 01 | |
| MO | RAILROAD MEDICARE PTAN | P00266673 | 01 |
| Street Address |
1135 E LAKEWOOD ST SUITE 104 |
| City | SPRINGFIELD |
| State | MO |
| Zip Code | 65810-2403 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225135171 | Donald P Kratz | Obstetrics & Gynecology | 1135 E Lakewood St, Suite112, Springfield, MO 65810-2434 | 2006-09-20 |
| 1336407949 | Faith Robin Jones | Nurse Practitioner | 1135 E Lakewood St, Suite 112, Springfield, MO 65810-2434 | 2012-05-02 |
| 1619206497 | Jill Ann Norton | Nurse Practitioner | 1135 E Lakewood St, Suite 112, Springfield, MO 65810-2434 | 2009-12-08 |
| 1184710832 | Amy Lynn Linn | Nurse Practitioner | 1135 E Lakewood St, Suite 112, Springfield, MO 65810-2434 | 2006-10-04 |
| 1841398401 | Woman's Clinic, Inc | Obstetrics & Gynecology | 1135 E Lakewood St, Suite112, Springfield, MO 65810-2434 | 2006-09-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508373838 | Sunterra Springfield Oc, LLC | Skilled Nursing Facility | 4935 S National Ave, Springfield, MO 65810 | 2018-01-09 |
| 1982119392 | Boyoung Park | Specialist/Technologist | 4355 S National Ave Apt 905, Springfield, MO 65810 | 2017-12-07 |
| 1578086310 | Missouri Telerad LLC | Radiology | 5117 South Neffleton Avenue, Springfiled, MO 65810 | 2017-07-24 |
| 1245597285 | Intrepid of Missouri, Inc. | Hospice Care, Community Based | 4305 S. National Ave., Springfield, MO 65810 | 2012-04-16 |
| 1700199668 | Telerad of Mo Account Management, LLC | Radiology | 5117 S. Neffleton Ave, Springfield, MO 65810 | 2010-07-21 |
| 1427286251 | Sam's Club Optical | Eyewear Supplier (Equipment, not the service) | 745 W El Camino Alto Drive, Springfield (s), MO 65810 | 2009-07-01 |
| 1033344304 | Teresa Mary Kaelin | Occupational Therapist | 3291 W. Ridge Run, Springfield, MO 65810 | 2009-05-15 |
| 1538366448 | Rani K Nair | Internal Medicine | 3231 S National Mercy Endocrineology, Ste 440, Springfield, MO 65810 | 2007-07-03 |
| 1467672519 | Missouri Dental Professionals, Richard Straus, Dmd, PC | Dentist | 4955 S. National Ave., Unit A, Springfield, MO 65810 | 2007-04-30 |
| 1336161983 | Leo Allan Tokarczyk | Dentist | 4777 S National Ave, Springfield, MO 65810 | 2006-07-24 |
| Find all providers in zip 65810 | ||||
| Taxonomy Code | 207RE0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Endocrinology, Diabetes & Metabolism |
| An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457866519 | Mohammad Jamal Uddin Ansari | Internal Medicine | 751 N Rutledge St Ste 400, Springfield, IL 62702 | 2017-12-11 |
| 1710243621 | Michele A Gortakowski | Internal Medicine | 3300 Main St Fl 3, Springfield, MA 01107-1112 | 2012-04-04 |
| 1538319447 | Joy Debbie Sudler | Internal Medicine | 28 Cottage Ln, Springfield, NJ 07081-2303 | 2008-09-27 |
| 1295714657 | Catherine M Hegarty | Internal Medicine | 2150 Main Street, Springfield, MA 01104 | 2006-01-13 |
| 1174510978 | Marina K Russo | Internal Medicine | 1118 Legacy Pointe Dr, Springfield, IL 62711 | 2005-10-05 |
| 1124023726 | Linda R. Macgorman | Internal Medicine | 960 E Walnut Lawn, Suite 201, Springfield, MO 65807 | 2005-06-20 |
| 1871948414 | Prospect Health Access Network, Inc. | Internal Medicine | 190 W Sproul Rd, Suite 102, Springfield, PA 19064-2027 | 2016-05-02 |
| 1467894527 | Sanober Parveen | Internal Medicine | 751 N Rutledge St Ste 1700, Springfield, IL 62702-4968 | 2013-07-17 |
| 1811338841 | Mariam Murtaza Ali | Internal Medicine | 751 N Rutledge St Ste 1700, Springfield, IL 62702-4968 | 2013-07-05 |
| 1316382823 | Cecilia A Davis | Internal Medicine | 3300 Main Street, Springfield, MA 01107-1112 | 2013-05-10 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 65810 |
Please comment or provide details below to improve the information on IRON BRIDGE DIABETES & ENDO.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.