Provider Demographics
NPI:1063474484
Name:WOLLMERING, MARY MARGARET (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:MARGARET
Last Name:WOLLMERING
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 770
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65615-0770
Mailing Address - Country:US
Mailing Address - Phone:417-336-9728
Mailing Address - Fax:417-337-9710
Practice Address - Street 1:545 BRANSON LANDING BLVD.
Practice Address - Street 2:STE. #306
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616
Practice Address - Country:US
Practice Address - Phone:417-336-9728
Practice Address - Fax:417-337-9710
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2007-12-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2005031309208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
206576OtherBCBS
250766OtherHEALTHLINK
P00266172OtherRAILROAD MEDICARE
MOG55481Medicare UPIN