Healthcare Provider Details

I. General information

NPI: 1427086933
Provider Name (Legal Business Name): PAUL FAUD NASSAB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 04/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19550 E 39TH ST S STE 410
INDEPENDENCE MO
64057-2307
US

IV. Provider business mailing address

2790 CLAY EDWARDS DR STE 600
NORTH KANSAS CITY MO
64116-3276
US

V. Phone/Fax

Practice location:
  • Phone: 816-303-2400
  • Fax: 816-303-2484
Mailing address:
  • Phone: 816-561-3003
  • Fax: 816-889-1584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number2006008759
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: