Healthcare Provider Details

I. General information

NPI: 1932182763
Provider Name (Legal Business Name): SUSAN RENEE ANDERSON-JONES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSAN RENEE ANDERSON M.D.

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 GLENN HENDREN DR PAIN MANAGEMENT
LIBERTY MO
64068-9625
US

IV. Provider business mailing address

PO BOX 219672
KANSAS CITY MO
64121-9672
US

V. Phone/Fax

Practice location:
  • Phone: 816-781-7200
  • Fax: 816-781-6973
Mailing address:
  • Phone: 816-781-7200
  • Fax: 816-781-6973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number106273
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number106273
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: