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NPI Code Detail

MEDICARE: CARL E LEDBETTER DO

MEDICARE: CARL E LEDBETTER DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianR9971MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1346237120
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARL E LEDBETTER DO
Provider Business Mailing Address
First Line : 1700 RAINBOW BLVD
Second Line :
City : EXCELSIOR SPRINGS
State : MO
Zip : 64024-1182
Country : US
Telephone Number : 816-630-6081
Fax Number : 816-629-3661
Provider Business Practice Location Address
First Line : 1700 RAINBOW BLVD
Second Line :
City : EXCELSIOR SPRINGS
State : MO
Zip : 64024-1182
Country : US
Telephone Number : 816-630-6081
Fax Number : 816-629-3661
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2005
Last Update Date : 01/23/2015

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Directions to “ CARL E LEDBETTER DO” Practice Location

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