Individual
JUDITH ANNE DASOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
363 EAST ROUTE 66, STRAFFORD, MO 65757
(417) 736-9837
(417) 736-9839
Mailing address
363 EAST ROUTE 66, STRAFFORD, MO 65757
(417) 736-9837
(417) 736-9839
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
R5061
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1841386281
—
MO
01
—
431560263
TRICARE WEST
—
01
—
P00782623
RAILROAD MEDICARE
—
Enumeration date
10/05/2006
Last updated
02/09/2010
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