Provider Demographics
NPI:1336172204
Name:RILEY, MEGAN ELIZABETH (DO)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:RILEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6215 RIVERGLEN RD
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-6684
Mailing Address - Country:US
Mailing Address - Phone:417-881-2655
Mailing Address - Fax:
Practice Address - Street 1:6215 RIVERGLEN RD
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-6684
Practice Address - Country:US
Practice Address - Phone:417-881-2655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000151560207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207218801Medicaid
MOPENDINGMedicaid
MORI0879923OtherMEDICARE
MOPENDINGMedicaid
MORI0879923OtherMEDICARE