Provider Demographics
NPI:1487605275
Name:HERRICK, THOMAS B (MD)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:B
Last Name:HERRICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1950 DIAMOND PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-4321
Mailing Address - Country:US
Mailing Address - Phone:816-842-6717
Mailing Address - Fax:816-842-2574
Practice Address - Street 1:2750 CLAY EDWARDS DR
Practice Address - Street 2:500
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3237
Practice Address - Country:US
Practice Address - Phone:816-842-6717
Practice Address - Fax:816-842-2574
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7G41208800000X
KS0433251208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
16404026OtherBCBS
340018009OtherRAILROAD MEDICARE
MOJ711485AMedicare PIN
16404026OtherBCBS