Provider Demographics
NPI:1205936853
Name:JARED J DIRKS MD PC
Entity type:Organization
Organization Name:JARED J DIRKS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:DIRKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:660-463-7966
Mailing Address - Street 1:905 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CONCORDIA
Mailing Address - State:MO
Mailing Address - Zip Code:64020-8335
Mailing Address - Country:US
Mailing Address - Phone:660-463-7966
Mailing Address - Fax:660-463-7729
Practice Address - Street 1:905 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CONCORDIA
Practice Address - State:MO
Practice Address - Zip Code:64020-8335
Practice Address - Country:US
Practice Address - Phone:660-463-7966
Practice Address - Fax:660-463-7729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005037602207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty