Healthcare Provider Details

I. General information

NPI: 1295744605
Provider Name (Legal Business Name): JOHN M WUBBENHORST JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 NE INDEPENDENCE AVE
LEES SUMMIT MO
64086-5544
US

IV. Provider business mailing address

28806 SE MORELAND SCHOOL RD
BLUE SPRINGS MO
64014-6006
US

V. Phone/Fax

Practice location:
  • Phone: 816-246-8000
  • Fax: 816-246-8207
Mailing address:
  • Phone: 816-229-4061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2004007620
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number2004007620
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: