Provider Demographics
NPI:1568466944
Name:CONNER, WALTER EDWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:EDWIN
Last Name:CONNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1004 CARONDELET DR
Mailing Address - Street 2:STE 430
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4801
Mailing Address - Country:US
Mailing Address - Phone:816-941-0800
Mailing Address - Fax:816-941-0080
Practice Address - Street 1:1004 CARONDELET DR
Practice Address - Street 2:STE 430
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4801
Practice Address - Country:US
Practice Address - Phone:816-941-0800
Practice Address - Fax:816-941-0080
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9372208C00000X
KS0418364208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201195906Medicaid
KS100451130AMedicaid
MO201195906Medicaid
MOD96025Medicare UPIN
KS100451130AMedicaid