Organization
FAMILY MEDICINE OF JEFFERSON CITY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL P LAVERY M.D. (OWNER/PRESIDENT)
(573) 659-7300
Entity
Organization
Contact information
Practice address
1616 SOUTHRIDGE DR, SUITE #203, JEFFERSON CITY, MO 65109-5677
(573) 659-7300
(573) 636-0555
Mailing address
1616 SOUTHRIDGE DR, SUITE #203, JEFFERSON CITY, MO 65109-5677
(573) 659-7300
(573) 636-0555
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R9J28
MO
Other
Enumeration date
09/21/2006
Last updated
08/22/2020
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