Individual
SUSAN VEGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
8 COUNTRY CLUB RD, COUNTRY CLUB, MO 64505-1014
(816) 232-0743
(816) 364-4151
Mailing address
8 COUNTRY CLUB RD, COUNTRY CLUB, MO 64505-1014
(816) 232-0743
(816) 364-4151
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R3P07
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18059179
BLUE CROSS BLUE SHIELD
MO
05
—
243615069
—
MO
01
—
P00415188
RAILROAD MEDICARE
MO
Enumeration date
03/09/2006
Last updated
01/26/2021
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