Individual
TERI A DEFFENBAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1125 MADISON ST, OB GYN ASSOCIATES, JEFFERSON CITY, MO 65101-5227
(573) 632-5510
(573) 632-5810
Mailing address
1125 MADISON ST, OB GYN ASSOCIATES, JEFFERSON CITY, MO 65101-5227
(573) 632-5510
(573) 632-5810
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
109200
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1060232
CCN
—
01
—
110518
BLUE CROSS BLUE SHIELD
—
01
—
160042443
RR MEDICARE
—
05
—
248040917
—
MO
01
—
277721
HEALTHLINK
—
05
—
506232909
—
MO
01
—
E93924
MERCY
—
Enumeration date
05/05/2006
Last updated
02/10/2016
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