Provider Demographics
NPI:1841338936
Name:CONGER, CHRISTOPHER C (DO)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:C
Last Name:CONGER
Suffix:
Gender:M
Credentials:DO
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 579
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65402
Mailing Address - Country:US
Mailing Address - Phone:573-458-3425
Mailing Address - Fax:573-426-2282
Practice Address - Street 1:105N LAWRENCE
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:MO
Practice Address - Zip Code:65453
Practice Address - Country:US
Practice Address - Phone:573-885-1077
Practice Address - Fax:573-885-1080
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO108738207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO244880811Medicaid
MOG73015Medicare UPIN
MO244880811Medicaid