Provider Demographics
NPI:1578672135
Name:JARSTAD, JOHN STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:STEVEN
Last Name:JARSTAD
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:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:ONE HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-882-1506
Practice Address - Fax:573-884-5575
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00026367207W00000X
MO2015030665207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9116JAOtherREGENCE AUBURN RYDER #
WAEV8144OtherREGENCE GROUP NUMBER
WA59460OtherL&I GROUP NUMBER
WA2147JAOtherREGENCE BURIEN RYDER #
WA7080781Medicaid
WA91162803298116A002OtherTRICARE/WPS BURIEN #
WA91162803298002A002OtherTRICARE & WPS AUBURN #
WA0870427OtherAETNA GROUP NUMBER
WA891451OtherCRIME VICTIMS GROUP #
WA8914516OtherCRIME VICTIMS INDIVIDUAL
WA91162803298003A002OtherTRICARE/WPS FED WAY #
WA180017371OtherRAILROAD MEDICARE IND #
WA8120586Medicaid
WA911628032OtherBLUE CROSS PREMERA
WAJA8144OtherREGENCE FEDERAL WAY RYDER
WA59459OtherL&I INDIVIDUAL NUMBER
WA59460OtherL&I GROUP NUMBER
WA9116JAOtherREGENCE AUBURN RYDER #
WA911628032OtherBLUE CROSS PREMERA