Provider Demographics
NPI:1750344933
Name:SMALLEY, STEPHEN R (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:R
Last Name:SMALLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6601 WINCHESTER AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64133-4677
Mailing Address - Country:US
Mailing Address - Phone:816-313-2677
Mailing Address - Fax:816-313-6000
Practice Address - Street 1:20375 W 151ST ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7218
Practice Address - Country:US
Practice Address - Phone:913-768-7200
Practice Address - Fax:913-768-9712
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1071642085R0001X
KS04-218242085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100189660AMedicaid
MO203673918Medicaid
MO203673918Medicaid
MO4226737AMedicare PIN
KS100189660AMedicaid