Provider Demographics
NPI:1740391606
Name:BURD, JEREMY A, (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:A,
Last Name:BURD
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:PO BOX 504407
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-4407
Mailing Address - Country:US
Mailing Address - Phone:816-932-7940
Mailing Address - Fax:816-932-7957
Practice Address - Street 1:4400 BROADWAY ST
Practice Address - Street 2:SUITE 407
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3498
Practice Address - Country:US
Practice Address - Phone:816-932-1711
Practice Address - Fax:816-932-1719
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050044312084P0800X
KS04-269952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207395500Medicaid
H33996Medicare UPIN
MOW19000010Medicare PIN