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JASON RUSSELL DILTS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
4401 WORNALL RD, KANSAS CITY, MO 64111-3220
(816) 932-2171
Mailing address
PO BOX 78009, SAINT LOUIS, MO 63178-8009
(866) 898-7142
(616) 975-9824

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
01062390A
IN
207P00000X
Emergency Medicine Physician
Primary
2008012452
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200573720A
KS
05
200573720B
KS
05
200573720C
KS
05
200573720D
KS
01
40474018
BCBS
Enumeration date
02/22/2007
Last updated
03/19/2009
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