Healthcare Provider Details

I. General information

NPI: 1609977768
Provider Name (Legal Business Name): FREDRIC GARY REGENSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 WORNALL RD SUITE 240
KANSAS CITY MO
64111-5941
US

IV. Provider business mailing address

1430 TULANE AVE # 8535
NEW ORLEANS LA
70112-2632
US

V. Phone/Fax

Practice location:
  • Phone: 816-932-7900
  • Fax: 816-932-7920
Mailing address:
  • Phone: 816-932-7940
  • Fax: 816-932-7957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number07834R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License NumberR9479
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: