Provider Demographics
NPI:1134215759
Name:KLINE, GUY R (MD)
Entity type:Individual
Prefix:DR
First Name:GUY
Middle Name:R
Last Name:KLINE
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 1:3045 S NATIONAL AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4247
Mailing Address - Country:US
Mailing Address - Phone:417-820-8991
Mailing Address - Fax:
Practice Address - Street 1:3045 S NATIONAL AVE STE 110
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4247
Practice Address - Country:US
Practice Address - Phone:417-820-8991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7C20207PE0004X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMOR7C20Medicaid
MO202099628Medicaid
MOA11180Medicare UPIN
MO021050229Medicare ID - Type UnspecifiedCPIN
MO021050220Medicare PIN