Provider Demographics
NPI:1710547831
Name:SEEVERS, JACOB BENJAMIN (DO)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:BENJAMIN
Last Name:SEEVERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-2511
Mailing Address - Country:US
Mailing Address - Phone:573-642-5911
Mailing Address - Fax:573-642-3015
Practice Address - Street 1:305 S PLATTE CLAY WAY
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:MO
Practice Address - Zip Code:64060-8214
Practice Address - Country:US
Practice Address - Phone:816-407-4820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019021425207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine