Healthcare Provider Details

I. General information

NPI: 1912004201
Provider Name (Legal Business Name): WILLIAM R JEWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 RAINBOW BLVD DEPT. OF SURGERY, MAIL STOP 1037
KANSAS CITY KS
66160-0001
US

IV. Provider business mailing address

3901 RAINBOW BLVD 4070 DELP MAIL STOP 4017
KANSAS CITY KS
66160-0001
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-6112
  • Fax: 913-588-7540
Mailing address:
  • Phone: 913-588-6112
  • Fax: 913-588-7540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number04-14880
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: