Provider Demographics
NPI:1316946304
Name:ALTHOFF, JEFFREY R (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:R
Last Name:ALTHOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2747
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66201-2747
Mailing Address - Country:US
Mailing Address - Phone:800-968-6866
Mailing Address - Fax:616-532-7230
Practice Address - Street 1:930 CARONDELET DR STE 200
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4698
Practice Address - Country:US
Practice Address - Phone:816-943-5690
Practice Address - Fax:816-943-3156
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMDR7N50207PE0004X, 207P00000X
KS0431677207PE0005X
MOR7N50207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100188060DMedicaid
18711019OtherBLUE CROSS BLUE SHIELD
MO202935821Medicaid
KS100188060AMedicaid