Provider Demographics
NPI:1720024557
Name:UHRIG, JACK R (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:R
Last Name:UHRIG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 104240
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65110-4240
Mailing Address - Country:US
Mailing Address - Phone:573-635-5264
Mailing Address - Fax:573-556-5757
Practice Address - Street 1:2303 S HIGHWAY 65
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-3702
Practice Address - Country:US
Practice Address - Phone:660-886-3364
Practice Address - Fax:660-886-6044
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR2B31207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201564119Medicaid
MO2774668Medicare PIN
MO201564119Medicaid