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General NPI Number Information
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NPI Number | 1417901935
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Entity Type | Individual
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Provider Name | JURIS PETERIS SIMANIS MD
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Gender | Male
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 12/10/2015
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Provider Practice Location Address
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Address Line | 1155 W. PARKVIEW STREET SUITE 2D
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City | BOLIVAR
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State | MO
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Zip | 65613-7800
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Country | US
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Telephone | 417-777-2663
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Fax | 417-777-2666
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Provider Business Mailing Address
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Address Line | 1500 N OAKLAND AVE
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City | BOLIVAR
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State | MO
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Zip | 65613-3011
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Country | US
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Telephone | 417-326-6000
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Fax | 417-328-6338
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2005018446
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 2005018446
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License Number State | MO
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