Healthcare Provider Details

I. General information

NPI: 1215976915
Provider Name (Legal Business Name): JOHN W SHOOK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 11/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 WORNALL RD STE 530
KANSAS CITY MO
64111-5941
US

IV. Provider business mailing address

901 E 104TH ST MAILSTOP 400
KANSAS CITY MO
64131
US

V. Phone/Fax

Practice location:
  • Phone: 816-932-2836
  • Fax:
Mailing address:
  • Phone: 816-502-8755
  • Fax: 816-932-9670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number425057
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR2F07
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number425057
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberR2F07
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number18126
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: