Individual
TERRY D SUPPES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
6675 HOLMES RD, SUITE 360, KANSAS CITY, MO 64131-1150
(816) 276-7600
(816) 276-7992
Mailing address
6675 HOLMES RD, SUITE 450, KANSAS CITY, MO 64131-1150
(816) 276-7600
(816) 276-7090
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
36974
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100234880C
—
KS
05
—
243112612
—
MO
01
—
P00121096
MEDICARE RAILROAD
MO
Enumeration date
06/04/2006
Last updated
07/11/2013
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