Provider Demographics
NPI:1841532637
Name:WADSWORTH, SHAWN (DO)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:
Last Name:WADSWORTH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7570 W. 21ST ST. N.
Mailing Address - Street 2:BUILDING 1042 SUITE A
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1236
Mailing Address - Country:US
Mailing Address - Phone:316-854-3526
Mailing Address - Fax:316-854-3511
Practice Address - Street 1:7570 W. 21ST ST. N.
Practice Address - Street 2:BUILDING 1042 SUITE A
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-6720
Practice Address - Country:US
Practice Address - Phone:316-854-3526
Practice Address - Fax:316-854-3511
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015016398207Q00000X
IADO-05296207Q00000X
MN64762207Q00000X
WAOP60914447207Q00000X
WI41-321207Q00000X
AZ007851207Q00000X
IL036147727207Q00000X
NE1957207Q00000X
SD11317207Q00000X
COCDR.0000392207Q00000X
UT11309988-1204207Q00000X
MEDO2940207Q00000X
KS05-39265207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine