Provider Demographics
NPI:1649273541
Name:KREBS, FESTUS J III (MD)
Entity type:Individual
Prefix:
First Name:FESTUS
Middle Name:J
Last Name:KREBS
Suffix:III
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 1:296 NE TUDOR RD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-5696
Mailing Address - Country:US
Mailing Address - Phone:816-524-4828
Mailing Address - Fax:816-524-4888
Practice Address - Street 1:296 NE TUDOR RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-5696
Practice Address - Country:US
Practice Address - Phone:816-524-4828
Practice Address - Fax:816-524-4888
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4E33174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO020007385OtherRAILROAD MEDICARE
MO13398011OtherBCBSKC
MO202123717Medicaid
MO13398011OtherBCBSKC
MO0006800Medicare ID - Type Unspecified