Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 102147 | MO |
N | 207PE0004X | Emergency Medical Services | 04-29528 | KS |
N | 207PE0004X | Emergency Medical Services | MD102147 | MO |
NPI | 1053310938 |
---|---|
Provider Name | Thad A Stephens |
First Address | Kansas City, MO 64114-4698 |
Second Address | Kansas City, MO 64114-4698 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2005 |
Last Update Date | 06/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100174340G | (05) | KS |
100174340H | (05) | KS |
F48503 | (02) | MO |