MEDICARE: SPEROS GABRIEL DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207X00000X	Orthopaedic Surgery Physician	4171794	ID

General Provider Information

NPI Number	:	1063094373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SPEROS GABRIEL DO

Provider Business Mailing Address
First Line	:	201 NW R D MIZE RD
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64014-2513
Country	:	US
Telephone Number	:	816-228-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 NW R D MIZE RD
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64014-2513
Country	:	US
Telephone Number	:	816-228-5900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2021
Last Update Date	:	03/31/2026

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Directions to “ SPEROS GABRIEL DO” Practice Location

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