Individual
DR. EDWIN ROEDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1210 N KENTUCKY AVE, WEST PLAINS, MO 65775
(417) 256-1745
(417) 256-1745
Mailing address
2828 N NATIONAL AVE, SPRINGFIELD, MO 65803-4306
(417) 837-4003
(417) 875-4782
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
112519
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003812645
—
MO
05
—
244688917
—
MO
01
—
P00061886
RR MEDICARE
—
Enumeration date
06/27/2005
Last updated
08/29/2018
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