Provider Demographics
NPI:1396701066
Name:RUTHERFORD, BARRY D (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:D
Last Name:RUTHERFORD
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 1:901 E 104TH ST
Mailing Address - Street 2:MAILSTOP 400S
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131
Mailing Address - Country:US
Mailing Address - Phone:816-502-7117
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:4330 WORNALL RD
Practice Address - Street 2:SUITE 2000
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5939
Practice Address - Country:US
Practice Address - Phone:816-931-1883
Practice Address - Fax:816-756-3645
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0430192207RC0000X
MOR7212207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100135180AMedicaid
KSKA1021037OtherMEDICARE - CUSHING
MO201106507Medicaid
KS100135180COtherMEDICAID - CUSHING
KS100135180FMedicaid
KSP00842639OtherRAILROAD MEDICARE
KS100135180EMedicaid
KSKA2004031Medicare PIN
KSKA1021037OtherMEDICARE - CUSHING
MOMA2491023Medicare PIN
KS100135180FMedicaid
KSKA1724031Medicare PIN