Provider Demographics
NPI:1134117328
Name:PROTZEL, HUGH RAYMOND (DPM)
Entity type:Individual
Prefix:DR
First Name:HUGH
Middle Name:RAYMOND
Last Name:PROTZEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-5812
Mailing Address - Country:US
Mailing Address - Phone:573-472-2202
Mailing Address - Fax:573-472-3720
Practice Address - Street 1:522 VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-5812
Practice Address - Country:US
Practice Address - Phone:573-472-2202
Practice Address - Fax:573-472-3720
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000625213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO303312409Medicaid
MO0557920001Medicare NSC
MOU23055Medicare UPIN
MO303312409Medicaid