Healthcare Provider Details

I. General information

NPI: 1730882598
Provider Name (Legal Business Name): GAGE ADAM BRUMMELL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 W 32ND ST
JOPLIN MO
64804-3503
US

IV. Provider business mailing address

PO BOX 3810
JOPLIN MO
64803-3810
US

V. Phone/Fax

Practice location:
  • Phone: 417-347-4570
  • Fax: 417-347-6755
Mailing address:
  • Phone: 417-347-8400
  • Fax: 471-347-5818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2026015310
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: