Individual
THOMAS E DAHLBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3322 S CAMPBELL AVE STE T-1, SPRINGFIELD, MO 65807-4980
(417) 220-4480
(417) 414-0017
Mailing address
3322 S CAMPBELL AVE STE T-1, SPRINGFIELD, MO 65807-4980
(417) 220-4480
(417) 900-2992
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD104392
MO
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
MD104392
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080170409
RR MEDICARE
—
05
—
1013013093
—
MO
05
—
207984428
—
MO
05
—
500128969
—
MO
Enumeration date
09/16/2006
Last updated
01/22/2024
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