Provider Demographics
NPI:1487650685
Name:KINDER, JOHN RECK (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RECK
Last Name:KINDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:64 DOCTORS PARK
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-4928
Mailing Address - Country:US
Mailing Address - Phone:573-334-5265
Mailing Address - Fax:573-334-3648
Practice Address - Street 1:64 DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4928
Practice Address - Country:US
Practice Address - Phone:573-334-5265
Practice Address - Fax:573-334-3648
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000154620207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1361772OtherUNITED MINE WORKERS
MO146189OtherHEALTH ALLIANCE
MOP8985OtherCHAMPUS/TRICARE
MO133729OtherGHP
MO128567OtherBLUE CROSS BLUE SHIELD
MO180039851OtherRAILROAD MEDICARE
MO431539OtherHEALTHLINK
MO507464709Medicaid
MO2580388OtherUNITED HEALTHCARE
MO000094812Medicare PIN
MO507464709Medicaid