Basic Information
| Provider Information | |||||||||
| NPI: | 1992743405 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUES | ||||||||
| FirstName: | LAWRENCE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6675 HOLMES, STE 360 | ||||||||
| Address2: | GOPPERT TRINITY FAMILY CARE | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162767600 | ||||||||
| FaxNumber: | 8162767992 | ||||||||
| Practice Location | |||||||||
| Address1: | 6675 HOLMES ROAD, STE 360 | ||||||||
| Address2: | GOPPERT TRINITY FAMILY CARE | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162767600 | ||||||||
| FaxNumber: | 8162767992 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2006 | ||||||||
| LastUpdateDate: | 07/17/2013 | ||||||||
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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 | 207Q00000X | 35549 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100642520A | 05 | KS | MEDICAID | 202066114 | 05 | MO | MEDICAID |