Provider Demographics
NPI:1841299740
Name:MOOK, DAVID GERARD (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GERARD
Last Name:MOOK
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:PO BOX 1500
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-1500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:156 MISSOURI BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LAURIE
Practice Address - State:MO
Practice Address - Zip Code:65038
Practice Address - Country:US
Practice Address - Phone:573-374-5263
Practice Address - Fax:573-374-4933
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201375227Medicaid
MOP00060709OtherRAILROAD MEDICARE
MO201375227Medicaid
MOP00060709OtherRAILROAD MEDICARE