Provider Demographics
NPI:1114950904
Name:ROPP, DOUGLAS RANDALL (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:RANDALL
Last Name:ROPP
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 410461
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-0461
Mailing Address - Country:US
Mailing Address - Phone:913-906-6570
Mailing Address - Fax:913-906-6550
Practice Address - Street 1:5520 COLLEGE BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1630
Practice Address - Country:US
Practice Address - Phone:913-906-6570
Practice Address - Fax:913-906-6550
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS54085367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100246330DMedicaid
KS100246330DMedicaid