Individual
DANIEL P LAVERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1616 SOUTHRIDGE DR, SUITE #203, JEFFERSON CITY, MO 65109-5677
(573) 659-7300
(573) 636-0555
Mailing address
710 SYCAMORE VALLEY DR, JEFFERSON CITY, MO 65109-3133
(573) 616-8832
(573) 635-2237
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R9J28
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
171243
HEALTHLINK
MO
01
—
185912
BLUE CROSS BLUE SHIELD
MO
01
—
202387284
UNITED HEALTHCARE
MO
Enumeration date
09/14/2006
Last updated
04/21/2021
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