Provider Demographics
NPI:1649386459
Name:CHERN, MOU SHYONG (MD)
Entity Type:Individual
Prefix:DR
First Name:MOU
Middle Name:SHYONG
Last Name:CHERN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:AVA
Mailing Address - State:MO
Mailing Address - Zip Code:65608-0218
Mailing Address - Country:US
Mailing Address - Phone:417-683-3511
Mailing Address - Fax:417-683-3521
Practice Address - Street 1:1301 NORTH HIGHWAY 5
Practice Address - Street 2:
Practice Address - City:AVA
Practice Address - State:MO
Practice Address - Zip Code:65608-0218
Practice Address - Country:US
Practice Address - Phone:417-683-3511
Practice Address - Fax:417-683-3521
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9371208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO01-00464OtherUNITED HEALTH CARE
MO1728882OtherFIRST HEALTH
MO7590OtherBLUE CROSS BLUE SHIELD
MO103464OtherHEALTH LINK
MO7590OtherBLUE CROSS BLUE SHIELD