# DR. AUDREY K MONTOOTH

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1730132895
- **Gender:** F
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 113043 | MO | Yes |

## Other

- **Enumeration date:** 05/18/2006
- **Last updated:** 10/03/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000013907 | ESSENCE | MO |
| 01 | — | 0102099 | UHC | MO |
| 05 | — | 205163207 | — | MO |
| 01 | — | 210862 | BCBS | MO |
| 01 | — | 290148 | GHP | MO |
| 01 | — | 438069 | HEALTHLINK | MO |
| 01 | — | 752695810MON | MERCY | MO |