Healthcare Provider Details

I. General information

NPI: 1942201348
Provider Name (Legal Business Name): JOHN B STURGEON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 W 75TH ST SUITE 310
SHAWNEE MISSION KS
66204-2205
US

IV. Provider business mailing address

PO BOX 803855
KANSAS CITY MO
64180-3855
US

V. Phone/Fax

Practice location:
  • Phone: 913-671-7803
  • Fax:
Mailing address:
  • Phone: 913-234-1350
  • Fax: 913-234-1108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0423283
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD114207
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: