Individual
DUSTIN GAMMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 820-2115
Mailing address
PO BOX 505164, SAINT LOUIS, MO 63150-5164
(855) 420-7900
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2014030981
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDIGN
—
MO
01
—
PENDING
MEDICARE
MO
05
—
PENDING
—
AR
05
—
PENDING
—
OK
Enumeration date
07/03/2013
Last updated
07/21/2022
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