Provider Demographics
NPI:1669654539
Name:THE FAMILY DOCTORS OFFICE PC
Entity Type:Organization
Organization Name:THE FAMILY DOCTORS OFFICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:CARDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-415-2999
Mailing Address - Street 1:WESTOWNE 3
Mailing Address - Street 2:SUITE 303
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068
Mailing Address - Country:US
Mailing Address - Phone:816-415-2999
Mailing Address - Fax:816-415-9989
Practice Address - Street 1:WESTOWNE 3
Practice Address - Street 2:SUITE 303
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068
Practice Address - Country:US
Practice Address - Phone:816-415-2999
Practice Address - Fax:816-415-9989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD107604207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q800000Medicare PIN