Individual
JAMES EREK VANRIESSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3805 S KANSAS EXPY, SPRINGFIELD, MO 65807-6989
(417) 269-0269
(417) 269-0279
Mailing address
PO BOX 4046, SPRINGFIELD, MO 65808-4046
(417) 269-5712
(417) 269-7567
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2004001491
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
198541
BLUE CROSS OF MO
—
05
—
207274101
—
MO
Enumeration date
09/20/2006
Last updated
12/06/2019
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