Individual
MARK RICHARD WAKEFIELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
ONE HOSPITAL DRIVE, COLUMBIA, MO 65212-0001
(573) 882-6500
(573) 884-7453
Mailing address
PO BOX 843966, KANSAS CITY, MO 64184-3966
(573) 884-3300
(573) 884-0943
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
106072
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209289404
—
MO
01
—
P00147243
RR MEDICARE
MO
01
—
P00415790
RAILROAD MEDICARE
MO
Enumeration date
05/25/2006
Last updated
05/20/2024
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