Individual
LISA GERETTE KOLB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1125 MADISON ST, JEFFERSON CITY, MO 65101-5227
(573) 634-2620
(573) 634-2033
Mailing address
1125 MADISON ST, JEFFERSON CITY, MO 65101-5227
(573) 634-2620
(573) 634-2033
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
106050
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110095712
RAILROAD MEDICARE
MO
05
—
206994907
—
MO
Enumeration date
09/26/2005
Last updated
02/10/2016
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