Provider Demographics
NPI:1720180953
Name:DRYMALSKI, MARK WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:WAYNE
Last Name:DRYMALSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7687
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7687
Mailing Address - Country:US
Mailing Address - Phone:573-882-2259
Mailing Address - Fax:
Practice Address - Street 1:3211 S PROVIDENCE RD
Practice Address - Street 2:BUILDING C
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-3644
Practice Address - Country:US
Practice Address - Phone:573-884-7100
Practice Address - Fax:573-884-7706
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012015962208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1720180953Medicaid
NE46022474373Medicaid
SD4992940OtherBLUE CROSS
1720180953OtherARAZ/AMERICA'S PPO
SD557891052232OtherPREFERRED ONE
SD7070OtherDAKOTACARE
SD254135OtherMIDLANDS CHOICE
MN457412000Medicaid
SDHP83524OtherHEALTHPARTNERS
SD2300567OtherMEDICA
SD57105K012OtherWPS TRICARE
MN6I567DROtherBLUE CROSS
SD7070OtherSD LICENSE
SD6000984Medicaid
MN92411422907OtherPRIMEWEST
SD370624200OtherDEPT OF LABOR
MN6I567DROtherCC SYSTEMS/ BLUE PLUS
SD557891052232OtherPREFERRED ONE
NE46022474373Medicaid