Provider Demographics
NPI:1205917481
Name:SHUCK, DAVID B (DO)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:SHUCK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14352 METCALF AVE
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-2987
Mailing Address - Country:US
Mailing Address - Phone:913-904-0271
Mailing Address - Fax:913-851-0071
Practice Address - Street 1:14352 METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-2987
Practice Address - Country:US
Practice Address - Phone:913-904-0271
Practice Address - Fax:913-851-0071
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0523677207VG0400X
FLOS 10193207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
103832OtherBCBS
KS100231640EMedicaid
A10712Medicare UPIN
103832OtherBCBS