Basic Information
| Provider Information | |||||||||
| NPI: | 1659351013 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIRKS | ||||||||
| FirstName: | JARED | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 SOUTHWEST BLVD | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641082019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162831145 | ||||||||
| FaxNumber: | 8162833603 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 SOUTHWEST BLVD | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641082019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162831145 | ||||||||
| FaxNumber: | 8162833603 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2006 | ||||||||
| LastUpdateDate: | 01/30/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2005037602 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.