Individual
DR. MARK H. ENTRUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3801 S NATIONAL AVE, SPRINGFIELD, MO 65807-5210
(417) 269-7728
(417) 269-7729
Mailing address
PO BOX 4046, SPRINGFIELD, MO 65808-4046
(417) 269-5712
(417) 269-7567
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
100131
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10066
BLUE CROSS MO
—
05
—
246655427
—
MO
Enumeration date
08/30/2006
Last updated
03/23/2020
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