Individual
VANCE R JERNSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5844 NW BARRY RD, STE 340, KANSAS CITY, MO 64154-1465
(816) 880-2770
Mailing address
PO BOX 504538, SAINT LOUIS, MO 63150-4538
(816) 932-7940
(816) 932-7957
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
04-21322
KS
207Y00000X
Otolaryngology Physician
19023
NE
207Y00000X
Otolaryngology Physician
Primary
R5C10
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0735977
—
IA
05
—
10025459400
—
NE
05
—
1558321380
—
MO
05
—
1735977
—
IA
01
—
34161
BCBSN
NE
Enumeration date
03/24/2006
Last updated
03/28/2012
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