Healthcare Provider Details

I. General information

NPI: 1730100132
Provider Name (Legal Business Name): FAISAL AHMAD BUKEIRAT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: FAISAL A BUKEIRAT MD, FACG

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE HOSPITAL DR
COLUMBIA MO
65212-0001
US

IV. Provider business mailing address

PO BOX 843966
KANSAS CITY MO
64184-3966
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-1434
  • Fax: 573-884-2290
Mailing address:
  • Phone: 573-884-3300
  • Fax: 573-884-0943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number17445
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME117348
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number17445
License Number StateWV
# 4
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2021049915
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: