Healthcare Provider Details

I. General information

NPI: 1831727437
Provider Name (Legal Business Name): ZACHARY GAUGHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
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: 816-404-0690
  • Fax: 816-404-0701
Mailing address:
  • Phone: 816-404-0690
  • Fax: 816-404-0701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2021029985
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: