Provider Demographics
NPI:1457305062
Name:ASHLEY, LILLARD G JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LILLARD
Middle Name:G
Last Name:ASHLEY
Suffix:JR
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 1:2000 SE BLUE PKWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-1041
Mailing Address - Country:US
Mailing Address - Phone:816-607-2950
Mailing Address - Fax:816-607-2990
Practice Address - Street 1:2000 SE BLUE PKWY
Practice Address - Street 2:SUITE 210
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-1041
Practice Address - Country:US
Practice Address - Phone:816-607-2950
Practice Address - Fax:816-607-2990
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6850207RC0000X
KS0416588207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
0004001258OtherAETNA PPO
431092652A027OtherCHAMPUS TRICARE
5629254OtherBLUE SHIELD OF KC HMO
5629254OtherBLUE SHIELD OF KC PPO
0004001258OtherAETNA
0004001258OtherAETNA HMO
060051904OtherMEDICARE RAILROAD
5629254OtherPHP FREEDOM
MO1457305062Medicaid
MO1457305062Medicaid
MOMA2231003Medicare PIN
MOMA3395001Medicare PIN
5629254OtherBLUE SHIELD OF KC HMO