Provider Demographics
NPI:1568467660
Name:CONDUFF, LESTER L (MD)
Entity Type:Individual
Prefix:DR
First Name:LESTER
Middle Name:L
Last Name:CONDUFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4941 N TOWNE CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-8280
Mailing Address - Country:US
Mailing Address - Phone:417-551-4810
Mailing Address - Fax:417-551-4814
Practice Address - Street 1:4941 N TOWNE CENTRE DR
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-8280
Practice Address - Country:US
Practice Address - Phone:417-551-4810
Practice Address - Fax:417-755-4814
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO119902207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204691323Medicaid
P00140688OtherRR MEDICARE
MO1568467660Medicaid
MOMA1327031Medicare PIN
049050115Medicare ID - Type Unspecified
MO204691323Medicaid