Provider Demographics
NPI:1225092372
Name:VERSTRAETE, JOHN CLAYTON (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CLAYTON
Last Name:VERSTRAETE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 MAIN ST
Mailing Address - Street 2:STE 100B
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2645
Mailing Address - Country:US
Mailing Address - Phone:816-561-8125
Mailing Address - Fax:816-931-8721
Practice Address - Street 1:3215 MAIN ST
Practice Address - Street 2:STE 100B
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2645
Practice Address - Country:US
Practice Address - Phone:816-561-8125
Practice Address - Fax:816-931-8721
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111192207RI0200X
KS05-28581207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO110248445OtherRAILROAD MEDICARE PPG
MO249662222Medicaid
MO440003964OtherRAILROAD MEDICARE
KSN448107BMedicare PIN
MO110248445OtherRAILROAD MEDICARE PPG
G71873Medicare UPIN