Provider Demographics
NPI:1346293230
Name:SAFLEY, THOMAS JENRY III (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JENRY
Last Name:SAFLEY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17221 E 23RD ST S
Mailing Address - Street 2:SUITE 207
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-1803
Mailing Address - Country:US
Mailing Address - Phone:816-373-4646
Mailing Address - Fax:816-373-7831
Practice Address - Street 1:17221 E 23RD ST S
Practice Address - Street 2:SUITE 207
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-1803
Practice Address - Country:US
Practice Address - Phone:816-373-4646
Practice Address - Fax:816-373-7831
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5477208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO21577OtherBNDD
MO21577OtherBNDD
E05008Medicare UPIN
MO21577OtherBNDD