Provider Demographics
NPI:1518959949
Name:GUERRA, ERICK J (MD)
Entity Type:Individual
Prefix:
First Name:ERICK
Middle Name:J
Last Name:GUERRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E. 104TH ST.
Mailing Address - Street 2:MAILSTOP 400N
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131
Mailing Address - Country:US
Mailing Address - Phone:816-251-5200
Mailing Address - Fax:816-251-5299
Practice Address - Street 1:4801 S CLIFF AVE STE 300
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-6954
Practice Address - Country:US
Practice Address - Phone:816-251-5200
Practice Address - Fax:816-251-5299
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002024941207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205927114Medicaid
MOH74000011Medicare PIN
MO205927114Medicaid
MO234892932OtherMISSOURI BNDD
H70310Medicare UPIN
MOW19C010Medicare PIN