Individual
DR. JERAD E WIDMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
22450 S HARRISON ST, STE. 100, SPRING HILL, KS 66083-3151
(913) 592-2720
(913) 592-2725
Mailing address
22450 S HARRISON ST, STE 100, SPRING HILL, KS 66083-3151
(913) 592-2720
(913) 592-2725
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
04-30763
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200300220D
—
KS
Enumeration date
06/09/2006
Last updated
10/23/2019
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