Provider Demographics
NPI:1033197553
Name:EGBERT, ANNE MARSH (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:MARSH
Last Name:EGBERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4630 W FARM ROAD 82
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-6065
Mailing Address - Country:US
Mailing Address - Phone:417-522-5551
Mailing Address - Fax:417-722-0001
Practice Address - Street 1:4630 W FARM ROAD 82
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-6065
Practice Address - Country:US
Practice Address - Phone:417-522-5551
Practice Address - Fax:417-722-0001
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO207011946207RH0002X
KS18742207RH0002X
MO2007011946207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR175726001Medicaid
431560263OtherTRICARE WEST
MO1033197553Medicaid
P00653972OtherRAILROAD MEDICARE
KSB68641Medicare UPIN
MO132300026Medicare PIN