Active NPI
Robert L. Wudel, D.O.
- Family Medicine Physician
- Desloge, MO
National Provider Identifier
1386776987
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 108029
- Practice address
- 330 N State St
Suite C
Desloge, MO 63601-3052 - Phone
- (573) 431-2829
- Fax
- (573) 431-7186
- NPI assigned
- Mar 9, 2007
- Last updated
- Jul 9, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 108029 | MO | Primary |
Addresses
Primary practice location
330 N State St
Suite C
Desloge, MO 63601-3052
Mailing address
330 N State St
Suite C
Desloge, MO 63601-3052
Phone (573) 431-2829
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 108029 | MO | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Farmington Clinic Company, LLC | Family Medicine | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Farmington Primary Care
- Rural Health Clinic/Center
- Farmington, MO
- NPI 1316223944
Family Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173398400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1386776987",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "330 N STATE ST",
"address_2": "SUITE C",
"city": "DESLOGE",
"state": "MO",
"postal_code": "636013052",
"telephone_number": "573-431-2829",
"fax_number": "573-431-7186"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "330 N STATE ST",
"address_2": "SUITE C",
"city": "DESLOGE",
"state": "MO",
"postal_code": "636013052",
"telephone_number": "573-431-2829",
"fax_number": "573-431-7186"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WUDEL",
"first_name": "ROBERT",
"middle_name": "L.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-09",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MO",
"license": "108029",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Desloge, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.