Provider Demographics
NPI:1336116789
Name:URE, JOHN D (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:URE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8768 NE 1174 PVT RD
Mailing Address - Street 2:
Mailing Address - City:DEEPWATER
Mailing Address - State:MO
Mailing Address - Zip Code:64740-8233
Mailing Address - Country:US
Mailing Address - Phone:417-644-2788
Mailing Address - Fax:
Practice Address - Street 1:8768 NE 1174 PVT RD
Practice Address - Street 2:
Practice Address - City:DEEPWATER
Practice Address - State:MO
Practice Address - Zip Code:64740-8233
Practice Address - Country:US
Practice Address - Phone:417-644-2788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4D38207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOC51679Medicare UPIN