Provider Demographics
NPI:1679636385
Name:VASKO, TRUMAN MARK (MD)
Entity Type:Individual
Prefix:
First Name:TRUMAN
Middle Name:MARK
Last Name:VASKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 MILLER ST
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:MO
Mailing Address - Zip Code:64424-2701
Mailing Address - Country:US
Mailing Address - Phone:660-425-2211
Mailing Address - Fax:660-425-2366
Practice Address - Street 1:2600 MILLER ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:MO
Practice Address - Zip Code:64424-2701
Practice Address - Country:US
Practice Address - Phone:660-425-2211
Practice Address - Fax:660-425-2366
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2004016727208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOF90006Medicare UPIN