Provider Demographics
NPI:1417901935
Name:SIMANIS, JURIS PETERIS (MD)
Entity Type:Individual
Prefix:
First Name:JURIS
Middle Name:PETERIS
Last Name:SIMANIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 N OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-3011
Mailing Address - Country:US
Mailing Address - Phone:417-326-6000
Mailing Address - Fax:417-328-6338
Practice Address - Street 1:1155 W. PARKVIEW STREET
Practice Address - Street 2:SUITE 2D
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-7800
Practice Address - Country:US
Practice Address - Phone:417-777-2663
Practice Address - Fax:417-777-2666
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005018446207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00389370OtherRAIL ROAD MEDICARE
MO206281503Medicaid
MO217133OtherBLUE SHIELD
MO777048OtherHEALTHLINK
MOP00389370OtherRAIL ROAD MEDICARE