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Individual

DR. JASON CARTER FAIRMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PSY.D.

Contact information

Practice address
2900 SW 13TH ST, LEES SUMMIT, MO 64081-3800
(816) 516-7114
(816) 437-7399
Mailing address
2900 SW 13TH ST, LEES SUMMIT, MO 64081-3800
(816) 516-7114
(816) 437-7399

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2004033756
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
191215
BLUE CROSS BLUE SHIELD
MO
05
498452606
MO
Enumeration date
10/28/2006
Last updated
05/18/2009
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