Provider Demographics
NPI:1235117425
Name:WU, XUJUN (MD)
Entity Type:Individual
Prefix:
First Name:XUJUN
Middle Name:
Last Name:WU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:WU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2817 MC CLELLAND BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1629
Mailing Address - Country:US
Mailing Address - Phone:417-206-4928
Mailing Address - Fax:417-206-4734
Practice Address - Street 1:2817 MC CLELLAND BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1629
Practice Address - Country:US
Practice Address - Phone:417-206-4928
Practice Address - Fax:417-206-4734
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2010-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006024391207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200092220AMedicaid
MO201431608Medicaid
OK200092230AMedicaid
KS200400660AMedicaid
OH2514363Medicaid
MO2006024391OtherSTATE OF MO LICENSE
OHWU4139701Medicare ID - Type Unspecified
MO201431608Medicaid
OK200092230AMedicaid