Provider Demographics
NPI:1659351013
Name:DIRKS, JARED J (MD)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:J
Last Name:DIRKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SOUTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-2019
Mailing Address - Country:US
Mailing Address - Phone:816-283-1145
Mailing Address - Fax:816-283-3603
Practice Address - Street 1:200 SOUTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2019
Practice Address - Country:US
Practice Address - Phone:816-283-1145
Practice Address - Fax:816-283-3603
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005037602207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA1500A001Medicare PIN