Provider Demographics
NPI:1932182763
Name:ANDERSON-JONES, SUSAN RENEE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:RENEE
Last Name:ANDERSON-JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:RENEE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 219672
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64121-9672
Mailing Address - Country:US
Mailing Address - Phone:816-781-7200
Mailing Address - Fax:816-781-6973
Practice Address - Street 1:2525 GLENN HENDREN DR
Practice Address - Street 2:PAIN MANAGEMENT
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-9625
Practice Address - Country:US
Practice Address - Phone:816-781-7200
Practice Address - Fax:816-781-6973
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO106273207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOG97561Medicare UPIN
MOR52D336Medicare PIN