=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235300344
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN B. STURGEON M.D. P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2008
-----------------------------------------------------
Last Update Date | 08/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8800 W 75TH ST STE 310
-----------------------------------------------------
City | SHAWNEE MISSION
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66204-2205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-671-7803
-----------------------------------------------------
Fax | 913-722-0012
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 803855
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64180-3855
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-234-1350
-----------------------------------------------------
Fax | 913-234-1108
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JOHN B STURGEON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 913-234-1350
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 0423283
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------