Provider Demographics
NPI:1144254822
Name:FOLZENLOGEN, ROBERT C (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:FOLZENLOGEN
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 1:10 E RIDGELEY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-3528
Mailing Address - Country:US
Mailing Address - Phone:303-518-0568
Mailing Address - Fax:
Practice Address - Street 1:10 E RIDGELEY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-3528
Practice Address - Country:US
Practice Address - Phone:303-518-0568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO113999207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO132733OtherBLUE SHIELD/BLUE CHOICE
MO201318607Medicaid
MO448126OtherHEALTHLINK
MO957241444Medicare PIN
MO448126OtherHEALTHLINK
MOA16787Medicare UPIN
MO957245236Medicare PIN
MO201318607Medicaid