Individual
DR. MARY DEEKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3348 AMERICAN AVE, JEFFERSON CITY, MO 65109-1079
(573) 761-7210
(573) 634-8802
Mailing address
3348 AMERICAN AVE, JEFFERSON CITY, MO 65109-1079
(573) 761-7210
(573) 634-8802
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
106715
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203845300
—
MO
Enumeration date
07/04/2006
Last updated
09/20/2012
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