Provider Demographics
NPI:1730127259
Name:PAPRECK, KERRIN THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:KERRIN
Middle Name:THOMAS
Last Name:PAPRECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
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:2006-06-04
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7652207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200329829Medicaid
MO200329845Medicaid
MO200329803Medicare ID - Type UnspecifiedM
MO200329829Medicaid
MOG69424Medicare UPIN