Provider Demographics
NPI:1245539816
Name:STIEFEL, GRETCHEN RAE (DO)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:RAE
Last Name:STIEFEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-3810
Mailing Address - Country:US
Mailing Address - Phone:417-347-8660
Mailing Address - Fax:417-347-8686
Practice Address - Street 1:1532 W 32ND ST
Practice Address - Street 2:STE 201
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1607
Practice Address - Country:US
Practice Address - Phone:417-347-8660
Practice Address - Fax:417-347-8686
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MO2015011441207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program