Individual
MATTHEW J TIEFENBRUNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1326 S SERVICE RD W STE 10, SULLIVAN, MO 63080-2306
(573) 468-4455
Mailing address
1326 S SERVICE RD W STE 10, SULLIVAN, MO 63080-2306
(573) 468-4455
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
117988
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080140048
RAILROAD MEDICARE
—
05
—
1457393712
—
MO
05
—
203922505
—
MO
Enumeration date
06/12/2006
Last updated
07/21/2022
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