Basic Information
| Provider Information | |||||||||
| NPI: | 1902242100 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLUGER | ||||||||
| FirstName: | IAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 E 5TH ST | ||||||||
| Address2: | |||||||||
| City: | FULTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652511753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5735922623 | ||||||||
| FaxNumber: | 5735923023 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 E 5TH ST | ||||||||
| Address2: | |||||||||
| City: | FULTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652511753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5735922623 | ||||||||
| FaxNumber: | 5735923023 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2013 | ||||||||
| LastUpdateDate: | 05/14/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | 01047 | MO | Y | Behavioral Health & Social Service Providers | Psychologist | Counseling |
No ID Information.