Provider Demographics
NPI:1992882328
Name:ALBRECHT, TAMMY G (MD)
Entity type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:G
Last Name:ALBRECHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4761 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:ELK CREEK
Mailing Address - State:MO
Mailing Address - Zip Code:65464-9632
Mailing Address - Country:US
Mailing Address - Phone:417-967-1056
Mailing Address - Fax:
Practice Address - Street 1:107 E PINE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MO
Practice Address - Zip Code:65483-1240
Practice Address - Country:US
Practice Address - Phone:417-967-0537
Practice Address - Fax:417-967-0542
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000161953207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205006109Medicaid
MO127013230Medicare ID - Type UnspecifiedMO MDCR #
MOG77793Medicare UPIN