Provider Demographics
NPI:1063509404
Name:SOMMERFELD, DAVID LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEE
Last Name:SOMMERFELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 S NATIONAL AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2219
Mailing Address - Country:US
Mailing Address - Phone:417-886-5000
Mailing Address - Fax:417-886-1100
Practice Address - Street 1:1911 S NATIONAL AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2219
Practice Address - Country:US
Practice Address - Phone:417-886-5000
Practice Address - Fax:417-886-1100
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO113752207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
113768OtherBLUE CROSS BLUE SHIELD
329974OtherHEALTHLINK
MO004012599OtherMEDICARE PTAN
MO209733815Medicaid
AR15377001Medicaid
390005293OtherRAILROAD MEDICARE
113768OtherBLUE CROSS BLUE SHIELD