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Individual

SALLY J ELLEBRACHT-GERKE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
17110 HIGHWAY 87, BOONVILLE, MO 65233-2939
(660) 672-7005
(660) 882-3147
Mailing address
17110 HIGHWAY 87, BOONVILLE, MO 65233-2939
(660) 672-7005
(660) 882-3147

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2001014617
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
209200401
MO
Enumeration date
07/02/2006
Last updated
04/18/2013
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