Provider Demographics
NPI:1295720340
Name:BOGNER, KENT A (DO)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:A
Last Name:BOGNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17067 S OUTER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-2165
Mailing Address - Country:US
Mailing Address - Phone:816-331-4000
Mailing Address - Fax:816-331-3626
Practice Address - Street 1:17067 S OUTER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-2165
Practice Address - Country:US
Practice Address - Phone:816-331-4000
Practice Address - Fax:816-331-3626
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODO 103426207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO248241317Medicaid
KS100453640AMedicaid
KS100453640BMedicaid
MO248241325Medicaid
MO1295720340Medicaid
KS100453640BMedicaid
MOC50447Medicare UPIN
KSP149256Medicare ID - Type Unspecified
MOP149256Medicare Oscar/Certification