Provider Demographics
NPI:1538245345
Name:KRETCHMAR, ALAN PAUL (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:PAUL
Last Name:KRETCHMAR
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 1:140 WESTMOUNT DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-2970
Mailing Address - Country:US
Mailing Address - Phone:573-756-2020
Mailing Address - Fax:573-756-6997
Practice Address - Street 1:140 WESTMOUNT DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-2970
Practice Address - Country:US
Practice Address - Phone:573-756-2020
Practice Address - Fax:573-756-6997
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6267207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4072783OtherAETNA
6267OtherEYEMED VISION CARE
100797OtherHEALTHLINK
10296OtherESSENCE HEALTHCARE
104342OtherGROUP HEALTH PLAN
180044514OtherRAILROAD MEDICARE
28482OtherUNITED HEALTHCARE
30134OtherCOORDINATED VISION CARE
103282OtherMERCY HEALTH PLANS
11943OtherOPTICARE EYE HEALTH NETWO
008254OtherEXCLUSIVE CHOICE FMH BENE
2121070010OtherCIGNA
011011383OtherMISSOURI MEDICARE
131611OtherBCBS
180044514OtherRAILROAD MEDICARE
MO011011383Medicare PIN