# FAMILY MEDICINE OF JEFFERSON CITY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043319957
- **Authorized official:** DANIEL P LAVERY M.D. (OWNER/PRESIDENT)
- **Authorized official phone:** (573) 659-7300

## Contact information

- **Practice address:** 1616 SOUTHRIDGE DR, SUITE \#203, JEFFERSON CITY, MO 65109-5677
- **Practice address phone:** (573) 659-7300
- **Practice address fax:** (573) 636-0555
- **Mailing address:** 1616 SOUTHRIDGE DR, SUITE \#203, JEFFERSON CITY, MO 65109-5677
- **Mailing address phone:** (573) 659-7300
- **Mailing address fax:** (573) 636-0555

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | R9J28 | MO | Yes |

## Other

- **Enumeration date:** 09/21/2006
- **Last updated:** 08/22/2020