Healthcare Provider Details

I. General information

NPI: 1659315083
Provider Name (Legal Business Name): JEFFREY METZNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E 24TH ST UNIT OFFICE53
KANSAS CITY MO
64108-2776
US

IV. Provider business mailing address

2310 HOLMES ST STE 800
KANSAS CITY MO
64108-2602
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-3710
  • Fax:
Mailing address:
  • Phone: 816-404-8188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number205020843
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: