Provider Demographics
NPI:1659361442
Name:KLAMET, TERRENCE GEORGE (DPM)
Entity Type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:GEORGE
Last Name:KLAMET
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 CHRISTY DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-5195
Mailing Address - Country:US
Mailing Address - Phone:573-634-3338
Mailing Address - Fax:573-634-3985
Practice Address - Street 1:1705 CHRISTY DR
Practice Address - Street 2:SUITE 209
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-5195
Practice Address - Country:US
Practice Address - Phone:573-634-3338
Practice Address - Fax:573-634-3985
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000552213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO302574710Medicaid
MO302574728Medicaid
MO002012764Medicare ID - Type UnspecifiedJEFF CITY MEDICARE NUMBER
MO302574710Medicaid