Gary W Dausmann, MD
Individual provider Active NPI Family Medicine Physician · Poplar Bluff, MO
NPI 1649259409 · NPPES record last updated Nov 5, 2015
Key facts
- NPI
- 1649259409
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- R3D64 (MO)
- Practice address
- 686 Lester St
Poplar Bluff, MO 63901-5025 - Phone
- (573) 686-2411
- Fax
- (573) 686-8452
- NPI assigned
- Jan 11, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R3D64 | MO | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Poplar Bluff Regional Medical Center LLC | Past | Accepting new patients | |
| Ozarks Medical Center | Family Medicine | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | R3D64 | MO | Yes |
Addresses
Primary practice location
686 Lester St
Poplar Bluff, MO 63901-5025
Mailing address
PO Box 220
Poplar Bluff, MO 63902-0220
Phone (573) 686-2411
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 080037680 | Other | TRAVELERS MEDICARE | |
| 201860400 | Medicaid | MO | |
| 108133001 | Medicaid | AR |
Other providers in Poplar Bluff, MO
- Jeffrey Lee Dakas
- Daniel Jackson DDS PC
- Lori Daniel
- Dennis Edwards Daniels
- Chasidy Darnell
- Reeca Daves
- Regina Lynn Davidson
- Andrew C.F. Davis-Cole
- Alicia Davis
- Damon Davis
All providers in Poplar Bluff, MO · Family Medicine Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 5, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.