Individual
JACOB K LUDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
705 HURON DR, SPARTA, MO 65753-1117
(417) 239-3392
Mailing address
705 HURON DR, SPARTA, MO 65753-1117
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
2000151553
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11171
COX HEALTH
MO
05
—
158591001
—
AR
01
—
194111
BCBS
MO
05
—
200077430A
—
OK
01
—
20174319965616B003
TRICARE
MO
05
—
204957104
—
MO
05
—
204957120
—
MO
01
—
430998
HEALTHLINK
MO
01
—
P00194821
RAILROAD
MO
Enumeration date
09/14/2005
Last updated
10/28/2022
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