Provider Demographics
NPI:1942201348
Name:STURGEON, JOHN B (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:STURGEON
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 803855
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-3855
Mailing Address - Country:US
Mailing Address - Phone:913-234-1350
Mailing Address - Fax:913-234-1108
Practice Address - Street 1:8800 W 75TH ST
Practice Address - Street 2:SUITE 310
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-2205
Practice Address - Country:US
Practice Address - Phone:913-671-7803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0423283207RG0100X
MOMD114207207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100159950BMedicaid
100014795OtherRR MEDICARE
KS424345OtherBLUE CROSS BLUE SHIELD KS
KS100514OtherBLUE CROSS BS GARNETT
20913039OtherBCBS OF KCMO INDIVIDUAL NUMBER UNDER GROUP 40286019
KS100159950BMedicaid
KSA79800001Medicare PIN
20913039OtherBCBS OF KCMO INDIVIDUAL NUMBER UNDER GROUP 40286019
100014795OtherRR MEDICARE