Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 2021030564 | MO |
N | 207Q00000X | Family Doctor | 256384 | MA |
NPI | 1003255845 |
---|---|
Provider Name | Nicholas Michael Lefevre |
First Address | Kansas City, MO 64184-3966 |
Second Address | Columbia, MO 65201-4236 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2013 |
Last Update Date | 05/01/2022 |