Healthcare Provider Details

I. General information

NPI: 1558347278
Provider Name (Legal Business Name): SEPEHRE NAFICY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 N RIVERSIDE RD STE 200
SAINT JOSEPH MO
64507-2553
US

IV. Provider business mailing address

802 N RIVERSIDE RD STE 200
SAINT JOSEPH MO
64507-2553
US

V. Phone/Fax

Practice location:
  • Phone: 816-271-6666
  • Fax: 816-271-1300
Mailing address:
  • Phone: 816-271-6666
  • Fax: 816-271-1300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number20177
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number81033
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number2024047702
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: