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General NPI Number Information
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NPI Number | 1811060767
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Entity Type | Organization
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Legal Business Name | BLUE SPRINGS FAMILY CARE PC
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 104 N. 7 HIGHWAY SUITE B
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City | BLUE SPRINGS
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State | MO
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Zip | 64014-7276
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Country | US
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Telephone | 816-229-8880
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Fax | 816-229-4363
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Provider Business Mailing Address
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Address Line | 104 N. 7 HIGHWAY SUITE B
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City | BLUE SPRINGS
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State | MO
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Zip | 64014-2726
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Country | US
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Telephone | 816-229-8880
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Fax | 816-229-4363
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN ERIC PETERSON
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Credential | DO
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Telephone | 816-229-8880
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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 |
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License Number State |
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