Healthcare Provider Details

I. General information

NPI: 1871579037
Provider Name (Legal Business Name): NATHAN DAVID BURROUGHS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 02/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9411 N OAK TRFY STE 202
KANSAS CITY MO
64155-2262
US

IV. Provider business mailing address

9411 N OAK TRFY SUITE LL1
KANSAS CITY MO
64155-2262
US

V. Phone/Fax

Practice location:
  • Phone: 816-468-8820
  • Fax: 816-468-8898
Mailing address:
  • Phone: 816-436-7072
  • Fax: 816-436-2743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberR5304
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number0415409
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: