Provider Demographics
NPI:1083719975
Name:LAVERY, DANIEL P (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:P
Last Name:LAVERY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:710 SYCAMORE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-3133
Mailing Address - Country:US
Mailing Address - Phone:573-616-8832
Mailing Address - Fax:573-635-2237
Practice Address - Street 1:1616 SOUTHRIDGE DR
Practice Address - Street 2:SUITE #203
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-5677
Practice Address - Country:US
Practice Address - Phone:573-659-7300
Practice Address - Fax:573-636-0555
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2021-04-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR9J28207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO171243OtherHEALTHLINK
MO202387284OtherUNITED HEALTHCARE
MO185912OtherBLUE CROSS BLUE SHIELD
MO185912OtherBLUE CROSS BLUE SHIELD
MO202387284OtherUNITED HEALTHCARE