Provider Demographics
NPI:1689829384
Name:BLEAZARD, JOHN SAMPSON (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:SAMPSON
Last Name:BLEAZARD
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:12639 OLD TESSON RD
Mailing Address - Street 2:STE 100
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2786
Mailing Address - Country:US
Mailing Address - Phone:913-381-5225
Mailing Address - Fax:913-901-0186
Practice Address - Street 1:10701 NALL AVE
Practice Address - Street 2:STE 200
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1358
Practice Address - Country:US
Practice Address - Phone:913-381-5225
Practice Address - Fax:913-901-0186
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2019-07-26
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Provider Licenses
StateLicense IDTaxonomies
MO2008018690207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery