Individual
DR. ROBERT P. WANKUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1241 W STADIUM BLVD, JEFFERSON CITY, MO 65109-6023
(573) 556-7709
(573) 556-1709
Mailing address
PO BOX 104240, JEFFERSON CITY, MO 65110-4240
(573) 556-7709
(573) 556-1709
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
35113
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0178712
HEALTHLINK
MO
01
—
12562
BCBS
MO
05
—
200090900
—
MO
01
—
5539
GHP
MO
01
—
826183199
MEDICARE RAILROAD
MO
01
—
CP9089
RAILROAD GROUP
MO
Enumeration date
12/13/2005
Last updated
08/07/2008
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