Healthcare Provider Details

I. General information

NPI: 1659336212
Provider Name (Legal Business Name): DANIEL T PURDOM JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 LEES SUMMIT RD
KANSAS CITY MO
64139-1236
US

IV. Provider business mailing address

825 EUCLID AVE
KANSAS CITY MO
64124-2323
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-7650
  • Fax:
Mailing address:
  • Phone: 816-474-4920
  • Fax: 816-889-1847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR8J68
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04-36500
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberR8J68
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: