Healthcare Provider Details

I. General information

NPI: 1659531515
Provider Name (Legal Business Name): STANLEY WILLIAM MCCLURG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2008
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6815 FRONTAGE RD
MERRIAM KS
66204-1398
US

IV. Provider business mailing address

5101 COLLEGE BLVD
LEAWOOD KS
66211-1614
US

V. Phone/Fax

Practice location:
  • Phone: 913-721-3387
  • Fax: 816-875-2598
Mailing address:
  • Phone: 816-478-4200
  • Fax: 816-875-2598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number0437088
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number2014008788
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: