1477507002 NPI number — DR. JAMES R EYNON MD

Table of content: DR. JAMES R EYNON MD (NPI 1477507002)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477507002 NPI number — DR. JAMES R EYNON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EYNON
Provider First Name:
JAMES
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477507002
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6420 PROSPECT ST
Provider Second Line Business Mailing Address:
T-509
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-276-4800
Provider Business Mailing Address Fax Number:
816-523-1425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6420 PROSPECT ST
Provider Second Line Business Practice Location Address:
T-509
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-276-4800
Provider Business Practice Location Address Fax Number:
816-523-1425
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  R9542 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X , with the licence number: 0419333 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 08010011 . This is a "BLUE SHIELD OF KC HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0007908025 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 060013885 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 08010011 . This is a "PHP FREEDOM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 431092652A014 . This is a "CHAMPUS TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 08010011 . This is a "BLUE SHEILD OF KC PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0007908025 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0007908025 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".




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