Provider Demographics
NPI:1629178090
Name:BRETH, JOHN J (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:BRETH
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3901 RAINBOW BLVD
Mailing Address - Street 2:4070 DELP MAIL STOP 4017
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160
Mailing Address - Country:US
Mailing Address - Phone:913-588-6670
Mailing Address - Fax:913-588-3365
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:4070 DELP MAIL STOP 4017
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-588-6670
Practice Address - Fax:913-588-3365
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2013-01-02
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Provider Licenses
StateLicense IDTaxonomies
KS04-27628207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205718703Medicaid
KS408870OtherFIRSTGUARD
KS100400170BMedicaid
MO29093029OtherBCBS KANSAS CITY
050083884Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MO205718703Medicaid
KS100400170BMedicaid