Individual
DAWNA MCCULLOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4401 WORNALL RD, KANSAS CITY, MO 64111-3220
(816) 932-2047
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
Primary
R1J29
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100142190E
—
KS
05
—
100142190F
—
KS
05
—
100142190G
—
KS
05
—
100142190H
—
KS
05
—
202549911
—
MO
01
—
26974063
BCBS
—
Enumeration date
08/17/2006
Last updated
06/09/2008
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