DR. CLEMENS E. HAGGERTY (NPI# 1952300923) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1952300923 |
Entity Type | Individual |
Full Name | DR. CLEMENS E. HAGGERTY |
Credential | D.O. |
Practice Address |
2333 Highway 17 Iberia MO 65486-9331 |
Mailing Address |
Po Box 1500 Osage Beach MO 65065-1500 |
Practice Telephone | 5737936900 |
Practice Fax Number | 5737936688 |
Enumeration Date | 2005-07-20 |
Last Update Date | 2012-12-06 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 208D00000X | General Practice | 30307 | MO | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
MO | RAILROAD MEDICARE | 010052082 | 01 |
MO | 240891200 | 05 |
Street Address |
2333 HIGHWAY 17 |
City | IBERIA |
State | MO |
Zip Code | 65486-9331 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1841749660 | Chelsie Deardeuff | Nurse Practitioner | 2333 Highway 17, Iberia, MO 65486-9331 | 2016-09-22 |
1891018784 | Lake Regional Health System | Clinic/Center | 2333 Highway 17, Iberia, MO 65486-9331 | 2010-03-05 |
1164515029 | Gary N Thomsen | Family Medicine | 2333 Highway 17, Iberia, MO 65486-9331 | 2006-10-02 |
1104853050 | Margaret C Hart | Nurse Practitioner | 2333 Highway 17, Iberia, MO 65486 | 2006-06-27 |
1821097718 | Robert E Mason | Family Medicine | 2333 Highway 17, Iberia, MO 65486-9331 | 2005-07-21 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1467571968 | Carl Sylvester Roberts Jr. | Family Medicine | 101e Main St, Iberia, MO 65486 | 2007-03-28 |
1093058034 | Medley Pharmacy Inc. | Durable Medical Equipment & Medical Supplies | 2322 Hwy 17, Iberia, MO 65486-0000 | 2013-03-28 |
1750402194 | Iberia R-v School District | Local Education Agency (LEA) | 201 Pemberton Dr, Iberia, MO 65486-0156 | 2007-04-03 |
1922052091 | Steven Edwin Reenan | Counselor | 986 Highway A, Iberia, MO 65486-8242 | 2006-05-21 |
1245660182 | Kyle Nichols | Pharmacist | 2322 Highway 17, Iberia, MO 65486-9115 | 2013-11-13 |
1700332020 | Brian Herzog | Music Therapist | 451 Tavern Creek Rd, Iberia, MO 65486-9193 | 2016-08-28 |
1396367025 | Rebekah Joy Carlson | Technician | 111 Walkin Rd, Iberia, MO 65486-9700 | 2020-05-15 |
Taxonomy Code | 208D00000X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | General Practice |
Definition to come... |
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1437707551 | Home Docs Medical Associates, LLC | General Practice | 7584 Olive Blvd Ste 204, University City, MO 63130-1600 | 2019-09-02 |
1912462912 | Thomas George Brett | General Practice | 800 Missouri 248, Building 3 Suite A, Branson, MO 65616 | 2019-02-04 |
1295208403 | Sme Kentucky Psc | General Practice | 5728 Pergola Dr Apt 207, Columbia, MO 65201-2897 | 2019-01-10 |
1821579798 | Healthy Schools Missouri LLC | General Practice | 3675 S Noland Rd Ste 200, Independence, MO 64055-3369 | 2018-08-28 |
1902300825 | Landmark Medical of Missouri PC | General Practice | 312 Sw Greenwich Dr # 315, Lees Summit, MO 64082-4408 | 2018-03-23 |
1740784214 | Bridge Integrative Medicine LLC | General Practice | 305 Nw Englewood Ct Ste 200, Kansas City, MO 64118 | 2018-03-20 |
1093218224 | Andrew Jason Doppelt | General Practice | 200 E Southampton Dr Ste 104, Columbia, MO 65203-3032 | 2018-03-14 |
1114427606 | Khrystal Robinson | General Practice | 902 E Reed St, Hayti, MO 63851-1243 | 2018-02-20 |
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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.