Provider Demographics
NPI:1912043316
Name:MEBRUER, EMILY H (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:H
Last Name:MEBRUER
Suffix:
Gender:F
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 4046
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808-4046
Mailing Address - Country:US
Mailing Address - Phone:417-269-5712
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:510 HIGHWAY 32
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-5303
Practice Address - Country:US
Practice Address - Phone:417-269-2278
Practice Address - Fax:417-269-2274
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO115777207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205285802Medicaid
MO205285802Medicaid
MO366013268Medicare PIN
MO112013230Medicare PIN