Provider Demographics
NPI:1548282064
Name:TEDROW, JEFFREY R (MD)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:R
Last Name:TEDROW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:821 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-2102
Mailing Address - Country:US
Mailing Address - Phone:660-826-4774
Mailing Address - Fax:660-827-8992
Practice Address - Street 1:17571 N DAM ACCESS RD
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:MO
Practice Address - Zip Code:65355-6396
Practice Address - Country:US
Practice Address - Phone:660-438-2717
Practice Address - Fax:660-827-8992
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR3M74207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202868501Medicaid
MO113190OtherBCBS MO #
MO80023034Medicare ID - Type UnspecifiedRR MEDICARE #