Provider Demographics
NPI:1366183832
Name:EGBERUARE, PATRICK JASON
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:JASON
Last Name:EGBERUARE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NE SAINT LUKES BLVD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-6000
Mailing Address - Country:US
Mailing Address - Phone:816-932-0340
Mailing Address - Fax:
Practice Address - Street 1:100 NE SAINT LUKES BLVD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-6000
Practice Address - Country:US
Practice Address - Phone:816-932-0340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program