Provider Demographics
NPI:1528411527
Name:STURGEON MEDICAL CLINIC PC
Entity Type:Organization
Organization Name:STURGEON MEDICAL CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:573-687-2019
Mailing Address - Street 1:208 N OGDEN ST
Mailing Address - Street 2:PO BOX 329
Mailing Address - City:STURGEON
Mailing Address - State:MO
Mailing Address - Zip Code:65284-9217
Mailing Address - Country:US
Mailing Address - Phone:573-687-2019
Mailing Address - Fax:
Practice Address - Street 1:208 N OGDEN ST
Practice Address - Street 2:
Practice Address - City:STURGEON
Practice Address - State:MO
Practice Address - Zip Code:65284-9217
Practice Address - Country:US
Practice Address - Phone:573-687-2019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-14
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8G92207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty