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General NPI Number Information
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NPI Number | 1740219476
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Entity Type | Organization
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Legal Business Name | ROBERT STURDEVANT, DO PEDIATRIC CARE, PC
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 03/03/2008
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Provider Practice Location Address
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Address Line | 811 WESTCHESTER AVE
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City | HARRISONVILLE
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State | MO
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Zip | 64701
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Country | US
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Telephone | 816-887-1987
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Fax |
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Provider Business Mailing Address
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Address Line | 811 WESTCHESTER AVE
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City | HARRISONVILLE
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State | MO
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Zip | 64701
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Country | US
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Telephone | 816-887-1987
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT BRIAN STURDEVANT
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Credential | DO
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Telephone | 816-887-1987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 105957
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License Number State | MO
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