Provider Demographics
NPI:1316143894
Name:BABCOCK, DAVID JEFFERY (DO)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JEFFERY
Last Name:BABCOCK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 801143
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-1143
Mailing Address - Country:US
Mailing Address - Phone:573-331-5583
Mailing Address - Fax:573-331-5079
Practice Address - Street 1:211 SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5049
Practice Address - Country:US
Practice Address - Phone:573-334-7575
Practice Address - Fax:573-334-7512
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007015921207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00418503OtherRAILROAD
MO405586OtherBCBS
MO110375OtherHEALTHLINK
IL$$$$$$$$$Medicaid
MO325540024Medicare PIN