Provider Demographics
NPI:1558776229
Name:STRANCKMEYER, SHAWN (MD)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:STRANCKMEYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5383 E PLEASANT VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65809-3175
Mailing Address - Country:US
Mailing Address - Phone:314-540-9894
Mailing Address - Fax:
Practice Address - Street 1:5383 E PLEASANT VALLEY LN
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65809-3175
Practice Address - Country:US
Practice Address - Phone:314-540-9894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-21
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014019429207Q00000X
MO1558776229207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine