Provider Demographics
NPI:1033163266
Name:THORNTON, JEFFREY W (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:W
Last Name:THORNTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2790 CLAY EDWARDS DR
Mailing Address - Street 2:SUITE 1235
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3276
Mailing Address - Country:US
Mailing Address - Phone:816-472-5157
Mailing Address - Fax:816-472-7201
Practice Address - Street 1:2790 CLAY EDWARDS DR
Practice Address - Street 2:SUITE 1235
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3276
Practice Address - Country:US
Practice Address - Phone:816-472-5157
Practice Address - Fax:816-472-7201
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2016-03-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE236622084N0400X
IA366172084N0400X
MO20080033162084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1718106Medicaid
NE95878OtherWELLMARK - 4242 FARNAM
NEP00325033OtherRR MEDICARE
IA13804OtherWELLMARK - SHENANDOAH
NE10025242300Medicaid
MO1033163266Medicaid
IA2718106Medicaid
NE250469OtherMIDLANDS CHOICE
IA0718106Medicaid
MOP00480717Medicare PIN
MO1033163266Medicaid
IA2718106Medicaid
MOMA1024001Medicare PIN