Individual
DR. CRAIG L PENDERGRASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
117 E HICKORY ST, NEOSHO, MO 64850-1806
(417) 451-4545
(417) 451-4546
Mailing address
PO BOX 220, NEOSHO, MO 64850-0220
(417) 451-4545
(417) 451-4546
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
110888
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100183590A
—
OK
05
—
100296690C
—
KS
01
—
110571
ANTHEM
MO
05
—
248916405
—
MO
01
—
P00248178
RR MEDICARE
—
Enumeration date
05/09/2006
Last updated
08/17/2023
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