Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VX0201X | Gynecologic Oncologist | 2005007820 | MO |
Y | 207VX0201X | Gynecologic Oncologist | 431352 | KS |
NPI | 1043266620 |
---|---|
Provider Name | Brenda Shoup |
First Address | Shawnee Mission, KS 66204-2207 |
Second Address | Shawnee Mission, KS 66204-2207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 10/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200459402 | (05) | MO |
2231144 | UHC (01) | |
35478013 | BCBS OF KC (01) | |
7727356 | AETNA (01) | |
77780 | HEALTHCARE USA (01) | |
H61382 | (02) | MO |
P00274849 | RAILROAD MEDICARE (01) |