Provider Demographics
NPI:1396816880
Name:REMBECKI, ROGER J (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:J
Last Name:REMBECKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 MATTOX DR
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:MO
Mailing Address - Zip Code:63080-2365
Mailing Address - Country:US
Mailing Address - Phone:573-860-6000
Mailing Address - Fax:573-860-6016
Practice Address - Street 1:965 MATTOX DR
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:MO
Practice Address - Zip Code:63080-2365
Practice Address - Country:US
Practice Address - Phone:573-860-6000
Practice Address - Fax:573-860-6016
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107596207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204720205Medicaid
MOH03666Medicare UPIN
MO091013230Medicare PIN