Basic Information
| Provider Information | |||||||||
| NPI: | 1487184537 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STIVERS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | JORDAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 802738 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641802738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057425300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 511 WINDSOR DR | ||||||||
| Address2: | |||||||||
| City: | STILLWATER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740746962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057070900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2017 | ||||||||
| LastUpdateDate: | 08/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 2017018508 | MO | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.