Provider Demographics
NPI:1740282516
Name:SHRIVER, REBECCA L (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:SHRIVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4517
Mailing Address - Country:US
Mailing Address - Phone:816-502-8752
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:4321 WASHINGTON ST
Practice Address - Street 2:SUITE 6000
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5961
Practice Address - Country:US
Practice Address - Phone:816-756-2255
Practice Address - Fax:816-931-4080
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO108392207RP1001X
KS0428721207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208552216Medicaid
KS104541OtherBCBS KS
MO29380026OtherBCBS KC
29380036OtherBCBS KC
KS100392950CMedicaid
MO021B034CMedicare ID - Type Unspecified
MO208552216Medicaid
KSW19A00039Medicare PIN
KS104541OtherBCBS KS
H35562Medicare UPIN
KS021B034AMedicare ID - Type Unspecified
MO021B034Medicare ID - Type Unspecified
KS104514Medicare ID - Type Unspecified