Basic Information
| Provider Information | |||||||||
| NPI: | 1679528673 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEW | ||||||||
| FirstName: | PAUL | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1010 CARONDELET DR | ||||||||
| Address2: | STE 220 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641144859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8169411600 | ||||||||
| FaxNumber: | 8169411699 | ||||||||
| Practice Location | |||||||||
| Address1: | 1010 CARONDELET DR | ||||||||
| Address2: | STE 220 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641144859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8169411600 | ||||||||
| FaxNumber: | 8169411699 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 07/19/2010 | ||||||||
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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 | 2083P0500X | 2000162374 | MO | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Preventive Medicine/Occupational Environmental Medicine |
ID Information
| ID | Type | State | Issuer | Description | 42969014 | 01 | MO | BLUECROSS BLUESHIELD OF KC | OTHER | 7798562 | 01 | MO | CIGNA HEALTHCARE OF KANSAS/MISSOURI, INC | OTHER | 7798562 | 01 | MO | AETNA US HEALTHCARE | OTHER |