Healthcare Provider Details

I. General information

NPI: 1710547831
Provider Name (Legal Business Name): JACOB BENJAMIN SEEVERS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 S PLATTE CLAY WAY
KEARNEY MO
64060-8214
US

IV. Provider business mailing address

110 N HOSPITAL DR
FULTON MO
65251-2511
US

V. Phone/Fax

Practice location:
  • Phone: 816-407-4820
  • Fax:
Mailing address:
  • Phone: 573-642-5911
  • Fax: 573-642-3015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2019021425
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: