Provider Demographics
NPI:1134212913
Name:CRAVENS, JEREMY WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:WILLIAM
Last Name:CRAVENS
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 1:6060 N OAK TRFY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64118-5130
Mailing Address - Country:US
Mailing Address - Phone:816-941-0800
Mailing Address - Fax:816-941-0080
Practice Address - Street 1:4370 W 109TH ST
Practice Address - Street 2:SUITE 350
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1361
Practice Address - Country:US
Practice Address - Phone:816-941-0800
Practice Address - Fax:816-941-0080
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-36763208C00000X
MO2013029750208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1134212913Medicare PIN
MO1134212913Medicare PIN