Individual
JURIS PETERIS SIMANIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1155 W. PARKVIEW STREET, SUITE 2D, BOLIVAR, MO 65613-7800
(417) 777-2663
(417) 777-2666
Mailing address
1500 N OAKLAND AVE, BOLIVAR, MO 65613-3011
(417) 326-6000
(417) 328-6338
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2005018446
MO
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
2005018446
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
206281503
—
MO
01
—
217133
BLUE SHIELD
MO
01
—
777048
HEALTHLINK
MO
01
—
P00389370
RAIL ROAD MEDICARE
MO
Enumeration date
05/20/2006
Last updated
12/10/2015
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