Provider Demographics
NPI:1063513612
Name:DAVES, JEREMY MICHAEL (CRNA)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:MICHAEL
Last Name:DAVES
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Gender:M
Credentials:CRNA
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Mailing Address - Street 1:1209 NW NORTH RIDGE DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-6320
Mailing Address - Country:US
Mailing Address - Phone:816-988-8415
Mailing Address - Fax:816-335-4003
Practice Address - Street 1:201 NW R D MIZE RD
Practice Address - Street 2:ANESTHESIA SERVICES OF BLUE SPRINGS/ST. MARY'S MEDICAL
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2513
Practice Address - Country:US
Practice Address - Phone:816-988-8415
Practice Address - Fax:816-335-4003
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2013-03-15
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Provider Licenses
StateLicense IDTaxonomies
MO2004031152367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO911059301Medicaid
MO911059301Medicaid
MOJ11D767Medicare PIN