Individual
DR. JAY R PEMBERTON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
201 W R D MIZE RD, BLUE SPRINGS, MO 64014-2518
(816) 228-5900
Mailing address
PO BOX 414965, KANSAS CITY, MO 64141-4965
(913) 234-1350
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
36771
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12605135
BCBS MO
MO
Enumeration date
08/16/2005
Last updated
07/08/2007
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