Healthcare Provider Details

I. General information

NPI: 1063701647
Provider Name (Legal Business Name): JOHN PAUL EGGERS MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 04/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 CLAY EDWARDS DR # DR600
KANSAS CITY MO
64116-3276
US

IV. Provider business mailing address

19550 E 39TH ST S STE 410
INDEPENDENCE MO
64057-2307
US

V. Phone/Fax

Practice location:
  • Phone: 816-561-3003
  • Fax: 816-889-1584
Mailing address:
  • Phone: 816-303-2400
  • Fax: 816-303-2484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number2014010093
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: