Healthcare Provider Details

I. General information

NPI: 1689883365
Provider Name (Legal Business Name): BRICE JAROD ZOGLEMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 RAINBOW BLVD. 6040 DELP, MS 1020 DIVISION OF GENERAL AND GERIATRIC MEDICINE, UNIVERSITY
KANSAS CITY KS
66160-0001
US

IV. Provider business mailing address

3901 RAINBOW BLVD. 4070 DELP, MS 4017 KANSAS UNIVERSITY PHYSICIANS, INC.
KANSAS CITY KS
66160-0001
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-6005
  • Fax: 913-588-3877
Mailing address:
  • Phone: 913-588-6005
  • Fax: 913-588-3877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number04-37888
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0106696A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number01066961A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01066961A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: