Healthcare Provider Details

I. General information

NPI: 1740219476
Provider Name (Legal Business Name): ROBERT STURDEVANT, DO PEDIATRIC CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 WESTCHESTER AVE
HARRISONVILLE MO
64701
US

IV. Provider business mailing address

811 WESTCHESTER AVE
HARRISONVILLE MO
64701
US

V. Phone/Fax

Practice location:
  • Phone: 816-887-1987
  • Fax:
Mailing address:
  • Phone: 816-887-1987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number105957
License Number StateMO

VIII. Authorized Official

Name: DR. ROBERT BRIAN STURDEVANT
Title or Position: PRESIDENT
Credential: DO
Phone: 816-887-1987