Provider Demographics
NPI:1568599694
Name:TENORIO, GENOVEVA (MD)
Entity Type:Individual
Prefix:DR
First Name:GENOVEVA
Middle Name:
Last Name:TENORIO
Suffix:
Gender:F
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:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:MO
Mailing Address - Zip Code:64402-0176
Mailing Address - Country:US
Mailing Address - Phone:660-726-3974
Mailing Address - Fax:660-726-3851
Practice Address - Street 1:1607 E US HIGHWAY 136
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:MO
Practice Address - Zip Code:64402-8223
Practice Address - Country:US
Practice Address - Phone:660-726-3974
Practice Address - Fax:660-726-3851
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO35774208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO07879044OtherBCBS
MO10001041401OtherCOMMUNITY HEALTH PLAN
MO07879044OtherBCBS
MOK784324Medicare ID - Type Unspecified