1669457743 NPI number — JAGPAL S GOSAL MD

Table of content: JAGPAL S GOSAL MD (NPI 1669457743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669457743 NPI number — JAGPAL S GOSAL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOSAL
Provider First Name:
JAGPAL
Provider Middle Name:
S
Provider Name Prefix Text:
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:
1669457743
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 116
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLUE SPRINGS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-287-2956
Provider Business Mailing Address Fax Number:
816-229-2341

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1912 NW COPPER OAKS CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLUE SPRINGS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64015-8300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-829-3700
Provider Business Practice Location Address Fax Number:
660-829-3701
Provider Enumeration Date:
12/12/2005

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: 2084P0800X , with the licence number:  114329 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 209734532 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com