Individual
MARY KAY VASKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1235 E CHEROKEE ST, PATHOLOGY, SPRINGFIELD, MO 65804-2203
(417) 820-6850
(417) 820-7790
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
Taxonomy
Speciality
Code
Description
License number
State
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
103092
MN
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
Primary
2009012968
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
077115000
—
MN
05
—
1043416464
—
MO
01
—
P00740243
RAILROAD MEDICARE
—
Enumeration date
06/22/2007
Last updated
05/15/2013
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