Provider Demographics
NPI:1255395695
Name:PINKERTON, MARK CLIFFORD (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:CLIFFORD
Last Name:PINKERTON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10940 PARALLEL PKWY
Mailing Address - Street 2:SUITE K-174
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66109-4431
Mailing Address - Country:US
Mailing Address - Phone:913-981-0830
Mailing Address - Fax:913-981-0831
Practice Address - Street 1:7211 W 110TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2339
Practice Address - Country:US
Practice Address - Phone:913-981-0830
Practice Address - Fax:913-981-0831
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS0431141207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100285420FMedicaid
MO1255395695Medicaid
MOJ36000003Medicare PIN
MOA01510Medicare UPIN
MO1255395695Medicaid
KS100285420FMedicaid