Basic Information
| Provider Information | |||||||||
| NPI: | 1033404967 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOERGEN | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | MATHEW | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6675 HOLMES RD | ||||||||
| Address2: | SUITE 450 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641311150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162767600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6675 HOLMES RD | ||||||||
| Address2: | SUITE 450 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641311150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162767600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2011 | ||||||||
| LastUpdateDate: | 06/20/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2011017852 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.