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NPI Code Detail

MEDICARE: JARED J DIRKS MD PC

MEDICARE: JARED J DIRKS MD PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician2005037602MO

General Provider Information

NPI Number : 1205936853
Entity Type Code : Organization
Provider Name (Legal Business Name) : JARED J DIRKS MD PC
Provider Business Mailing Address
First Line : 905 S MAIN ST
Second Line :
City : CONCORDIA
State : MO
Zip : 64020-8335
Country : US
Telephone Number : 660-463-7966
Fax Number : 660-463-7729
Provider Business Practice Location Address
First Line : 905 S MAIN ST
Second Line :
City : CONCORDIA
State : MO
Zip : 64020-8335
Country : US
Telephone Number : 660-463-7966
Fax Number : 660-463-7729
Authorized Official
Title or Position : PHYSICIAN
Name : JARED JAY DIRKS
Credential : M.D.
Telephone Number : 660-463-7966
Provider Enumeration Date : 09/24/2006
Last Update Date : 08/22/2020

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Directions to “JARED J DIRKS MD PC ” Practice Location

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