Basic Information
| Provider Information | |||||||||
| NPI: | 1053362079 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KINDER | ||||||||
| FirstName: | JERRY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 843225 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641843225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7086331234 | ||||||||
| FaxNumber: | 7083427100 | ||||||||
| Practice Location | |||||||||
| Address1: | 211 SAINT FRANCIS DR | ||||||||
| Address2: | |||||||||
| City: | CAPE GIRARDEAU | ||||||||
| State: | MO | ||||||||
| PostalCode: | 637035049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733315330 | ||||||||
| FaxNumber: | 5733315025 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 05/17/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 27632 | MO | Y | Allopathic & Osteopathic Physicians | Surgery | 207R00000X | 27632 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0470659087 | 05 | IL | MEDICAID | 200015915 | 05 | MO | MEDICAID | 440912 | 01 | HEALTHLINK | OTHER | 026299 | 01 | MO | BCBS | OTHER | 64068836 | 05 | KY | MEDICAID | 020053866 | 01 | RR MEDICARE | OTHER |