Provider Demographics
NPI:1912021635
Name:BOUDA, DAVID WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WILLIAM
Last Name:BOUDA
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 1:2316 E MEYER BLVD
Mailing Address - Street 2:1 CANCER WEST
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132-1136
Mailing Address - Country:US
Mailing Address - Phone:816-276-4700
Mailing Address - Fax:816-276-3810
Practice Address - Street 1:2316 E MEYER BLVD
Practice Address - Street 2:1 CANCER WEST
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-1136
Practice Address - Country:US
Practice Address - Phone:816-276-4700
Practice Address - Fax:816-276-3810
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM9684207RX0202X
NE17823207RX0202X
KS04-19028207RX0202X
MO2008034882207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100392480CMedicaid
KS100392480BMedicaid
MO1467427740Medicaid
27165530BDMedicare ID - Type Unspecified
MO1467427740Medicaid
KSKA1450003Medicare PIN
MOP00729461Medicare PIN
KS100392480CMedicaid
B69035Medicare UPIN