1437200482 NPI number — DR. DAVID A DEER M.D.

Table of content: DR. DAVID A DEER M.D. (NPI 1437200482)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437200482 NPI number — DR. DAVID A DEER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEER
Provider First Name:
DAVID
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437200482
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16630 S COUNTRY CLUB CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VILLAGE OF LOCH LLOYD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64012-3376
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-425-4931
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 ARKANSAS ST
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66044-1335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-749-3600
Provider Business Practice Location Address Fax Number:
785-749-3621
Provider Enumeration Date:
01/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  04-14419 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 060604 . This is a "BSKS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100202800A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2450136 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10765 . This is a "COVENTRY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10098026 . This is a "BSKC" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 10098026 . This is a "PHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 300016981 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: CIGNA . This is a "025" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10001646800 . This is a "COMMUNITY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 85489 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: A001 . This is a "TRI-CARE CHAMPUS" identifier . This identifiers is of the category "OTHER".




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