Provider Demographics
NPI:1982055372
Name:LERSCH, STEPHANIE ANN (MD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:LERSCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ANN
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8417 CLINT DR
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-5330
Mailing Address - Country:US
Mailing Address - Phone:660-493-3007
Mailing Address - Fax:660-235-2114
Practice Address - Street 1:8417 CLINT DR
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012
Practice Address - Country:US
Practice Address - Phone:660-493-3007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016021995207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine