Individual
DORRIE C TREDWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1512 N GREEN MOUNT RD, SUITE 108, O FALLON, IL 62269-2083
(618) 624-5510
(618) 624-5529
Mailing address
1512 N GREEN MOUNT RD, SUITE 108, O FALLON, IL 62269-2083
(618) 624-5510
(618) 624-5529
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036108951
IL
207Q00000X
Family Medicine Physician
2008010712
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
156490007
MO PTAN
MO
Enumeration date
08/15/2005
Last updated
12/20/2021
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