Healthcare Provider Details

I. General information

NPI: 1568429066
Provider Name (Legal Business Name): JAY MATTHEW PORTNOY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 GILLHAM RD
KANSAS CITY MO
64108-4619
US

IV. Provider business mailing address

2401 GILLHAM RD
KANSAS CITY MO
64108-4619
US

V. Phone/Fax

Practice location:
  • Phone: 816-234-3097
  • Fax: 816-346-1301
Mailing address:
  • Phone: 816-234-3097
  • Fax: 816-346-1301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number04-22504
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberR5E99
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: