Basic Information
| Provider Information | |||||||||
| NPI: | 1578133005 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOLBER | ||||||||
| FirstName: | CLAIRE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 308 S CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | FAYETTE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652481243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6602482217 | ||||||||
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| Practice Location | |||||||||
| Address1: | 110 N HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | FULTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652512511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736425911 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2021 | ||||||||
| LastUpdateDate: | 06/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2021024721 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.