Provider Demographics
NPI:1972728582
Name:DANNER, SHAVONNE L (MD)
Entity type:Individual
Prefix:DR
First Name:SHAVONNE
Middle Name:L
Last Name:DANNER
Suffix:
Gender:F
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 455
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64069-0455
Mailing Address - Country:US
Mailing Address - Phone:816-407-2028
Mailing Address - Fax:816-407-4606
Practice Address - Street 1:2525 GLENN HENDREN DR
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-9625
Practice Address - Country:US
Practice Address - Phone:816-407-2028
Practice Address - Fax:816-407-4880
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3N16207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
20-3816786OtherTAX ID
MOP00317963OtherRR MEDICARE
MO270921OtherCOVENTRY
MO16266183OtherBCBS KC
1134201OtherAETNA
MO16266183OtherBCBS KC
MOP00317963OtherRR MEDICARE