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General NPI Number Information
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NPI Number | 1235391467
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Entity Type | Individual
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Provider Name | JOHN RICHARD EPEMA D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/29/2008
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Last Update Date | 07/13/2023
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Provider Practice Location Address
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Address Line | 3662 TAFT AVE SW
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City | WYOMING
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State | MI
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Zip | 49519-3759
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Country | US
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Telephone | 573-230-6007
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Fax |
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Provider Business Mailing Address
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Address Line | 3662 TAFT AVE SW
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City | WYOMING
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State | MI
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Zip | 49519-3759
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Country | US
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Telephone | 573-230-6007
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 2012003982
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 5101017660
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License Number State | MI
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