Individual
SHELBY D RIFKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1432 SOUTHWEST BLVD, JEFFERSON CITY, MO 65109-2444
(573) 632-4800
(573) 632-5874
Mailing address
PO BOX 1128, JEFFERSON CITY, MO 65102-1128
(573) 632-4800
(573) 632-5874
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036-043437
IL
207RH0000X
Hematology (Internal Medicine) Physician
036-043437
IL
207RH0003X
Hematology & Oncology Physician
036043437
IL
207RH0003X
Hematology & Oncology Physician
Primary
21520-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-043437
—
IL
01
—
123240003
MEDICARE PTAN
MO
Enumeration date
10/05/2005
Last updated
04/28/2021
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