Individual
DR. SHAVONNE L DANNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2525 GLENN HENDREN DR, LIBERTY, MO 64068-9625
(816) 407-2028
(816) 407-4880
Mailing address
PO BOX 455, LIBERTY, MO 64069-0455
(816) 407-2028
(816) 407-4606
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
R3N16
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1134201
AETNA
—
01
—
16266183
BCBS KC
MO
01
—
20-3816786
TAX ID
—
01
—
270921
COVENTRY
MO
01
—
P00317963
RR MEDICARE
MO
Enumeration date
04/17/2007
Last updated
02/19/2010
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