Provider Demographics
NPI:1578605663
Name:COURTER, GARY M (DO)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:M
Last Name:COURTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2580
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-2580
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:417-829-4316
Practice Address - Street 1:120 HOSPITAL DR
Practice Address - Street 2:SUITE 250
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-9238
Practice Address - Country:US
Practice Address - Phone:417-533-6717
Practice Address - Fax:417-533-6718
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO32869207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO240434126Medicaid
MO98578OtherAR BLUE SHIELD #
MO240434126Medicaid
MO320013268Medicare PIN
MO023013230Medicare PIN