Provider Demographics
NPI:1891134094
Name:YUTZ, RACHEL (DO)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:YUTZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:DORSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:STE. 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:573-815-8130
Mailing Address - Fax:573-815-8149
Practice Address - Street 1:1605 E BROADWAY
Practice Address - Street 2:STE. 110
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8023
Practice Address - Country:US
Practice Address - Phone:573-815-8130
Practice Address - Fax:573-815-8149
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016012321207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine