Provider Demographics
NPI:1639283369
Name:EWING, DAVID L (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:EWING
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:105 FAR WEST DR
Mailing Address - Street 2:STE 201
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-3511
Mailing Address - Country:US
Mailing Address - Phone:816-271-8182
Mailing Address - Fax:816-271-8183
Practice Address - Street 1:105 FAR WEST DR
Practice Address - Street 2:STE 201
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3511
Practice Address - Country:US
Practice Address - Phone:816-271-8182
Practice Address - Fax:816-271-8183
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2023-01-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO20130066402084N0400X
CO311292084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01311299Medicaid
MO200003513Medicaid
KS110621028Medicare PIN
MO701000179Medicare PIN