Healthcare Provider Details

I. General information

NPI: 1467640235
Provider Name (Legal Business Name): SHAVONNE L. DANNER, M.D., L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 GLENN HENDEN DR
LIBERTY MO
64068
US

IV. Provider business mailing address

PO BOX 455
LIBERTY MO
64069-0455
US

V. Phone/Fax

Practice location:
  • Phone: 816-407-2028
  • Fax: 816-407-4606
Mailing address:
  • Phone: 816-407-2028
  • Fax: 816-407-4606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAVONNE DANNER
Title or Position: OWNER
Credential: MD
Phone: 816-407-2028