Healthcare Provider Details

I. General information

NPI: 1487761250
Provider Name (Legal Business Name): THOMAS HAYDEN GILL II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 E 24TH ST
KANSAS CITY MO
64108-2606
US

IV. Provider business mailing address

660 E 24TH ST
KANSAS CITY MO
64108-2606
US

V. Phone/Fax

Practice location:
  • Phone: 816-881-6610
  • Fax: 816-404-1345
Mailing address:
  • Phone: 816-881-6610
  • Fax: 816-404-1345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number2003001213
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: