Basic Information
| Provider Information | |||||||||
| NPI: | 1376741173 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STURGELL | ||||||||
| FirstName: | JEREMY | ||||||||
| MiddleName: | LOWELL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 175 SE 3RD LN | ||||||||
| Address2: | |||||||||
| City: | LAMAR | ||||||||
| State: | MO | ||||||||
| PostalCode: | 647599212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4176609157 | ||||||||
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| Practice Location | |||||||||
| Address1: | 29 NW 1ST LN | ||||||||
| Address2: | |||||||||
| City: | LAMAR | ||||||||
| State: | MO | ||||||||
| PostalCode: | 647598105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4176815100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2007 | ||||||||
| LastUpdateDate: | 09/11/2014 | ||||||||
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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 | 207P00000X | 125052413 | IL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 2009009836 | MO | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.