Provider Demographics
NPI:1023176880
Name:MALDONADO-DURAN, JESUS-MARTIN (MD)
Entity type:Individual
Prefix:
First Name:JESUS-MARTIN
Middle Name:
Last Name:MALDONADO-DURAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MARTIN
Other - Middle Name:
Other - Last Name:MALDONADO-DURAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2211 CHARLOTTE ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-2733
Mailing Address - Country:US
Mailing Address - Phone:816-404-5700
Mailing Address - Fax:
Practice Address - Street 1:2211 CHARLOTTE ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2733
Practice Address - Country:US
Practice Address - Phone:816-404-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS197412084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100933OtherBCBS
KS100933OtherBCBS