Healthcare Provider Details

I. General information

NPI: 1982602678
Provider Name (Legal Business Name): JOSEPH ROY VANBIBER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 08/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W R D MIZE RD SUITE 304
BLUE SPRINGS MO
64014-2518
US

IV. Provider business mailing address

205 W R D MIZE RD SUITE 304
BLUE SPRINGS MO
64014-2518
US

V. Phone/Fax

Practice location:
  • Phone: 816-228-4770
  • Fax: 816-228-1156
Mailing address:
  • Phone: 816-228-4770
  • Fax: 816-228-1156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR9E89
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: