Provider Demographics
NPI:1386643773
Name:ATWOOD, STEVEN DALE (M D)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:DALE
Last Name:ATWOOD
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 S NATIONAL AVE
Mailing Address - Street 2:STE 206
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-7310
Mailing Address - Country:US
Mailing Address - Phone:417-269-9200
Mailing Address - Fax:417-269-9204
Practice Address - Street 1:3525 S NATIONAL AVE
Practice Address - Street 2:STE 206
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-7310
Practice Address - Country:US
Practice Address - Phone:417-269-9200
Practice Address - Fax:417-269-9204
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1K19174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202763058Medicaid
MO18731OtherBLUE CROSS BLUE SHIELD OF
MO202763058Medicaid
43-1569320OtherTAX ID NUMBER
MO000094991Medicare ID - Type Unspecified