Provider Demographics
NPI:1184612889
Name:OO, TIN MAUNG (MD)
Entity type:Individual
Prefix:
First Name:TIN
Middle Name:MAUNG
Last Name:OO
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 1:100 ST. MARYS MEDICAL PLAZA
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101
Mailing Address - Country:US
Mailing Address - Phone:573-761-7000
Mailing Address - Fax:573-761-2068
Practice Address - Street 1:100 ST. MARYS MEDICAL PLAZA
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101
Practice Address - Country:US
Practice Address - Phone:573-761-7000
Practice Address - Fax:573-761-2068
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN028356207R00000X
MO2005036210207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000728945AMedicaid
G37396Medicare UPIN
GA000728945AMedicaid