Provider Demographics
NPI:1770584310
Name:REEVES, RYAN C
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:C
Last Name:REEVES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 W 74TH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66204-4004
Mailing Address - Country:US
Mailing Address - Phone:913-676-2214
Mailing Address - Fax:
Practice Address - Street 1:9100 W 74TH ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-4004
Practice Address - Country:US
Practice Address - Phone:913-676-2214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-29138207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100392430DMedicaid
MO34694032OtherBCBS OF KC MO
KS34694012OtherBCBS KC MO
01674018OtherBCBS KCMO GROUP 01674018
KS100392430BMedicaid
MO207493503Medicaid
KS100392430HMedicaid
P00136511OtherRR MEDICARE GROUP CC8899
P00188859OtherRR MEDICARE GROUP DC6712
KS763D034Medicare PIN
KS110990027Medicare PIN
KS34694012OtherBCBS KC MO
P00136511OtherRR MEDICARE GROUP CC8899