Provider Demographics
NPI:1093770299
Name:SMITH, SHADRACH J JR (MD)
Entity Type:Individual
Prefix:
First Name:SHADRACH
Middle Name:J
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:12140 NALL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209
Mailing Address - Country:US
Mailing Address - Phone:913-451-8500
Mailing Address - Fax:913-451-1754
Practice Address - Street 1:12140 NALL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209
Practice Address - Country:US
Practice Address - Phone:913-451-8500
Practice Address - Fax:913-451-1754
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2013-07-24
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Provider Licenses
StateLicense IDTaxonomies
MO2000174361207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOC50468Medicare UPIN