Healthcare Provider Details

I. General information

NPI: 1043743172
Provider Name (Legal Business Name): GRANT PARKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2017
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 HOLMES ST
KANSAS CITY MO
64108-2640
US

IV. Provider business mailing address

2301 HOLMES ST
KANSAS CITY MO
64108-2640
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-4175
  • Fax: 816-404-9480
Mailing address:
  • Phone: 816-404-4175
  • Fax: 816-404-9480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2017017622
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2017017622
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: