Healthcare Provider Details

I. General information

NPI: 1083610539
Provider Name (Legal Business Name): GWENDOLYN ARNETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4321 WASHINGTON ST STE 1000
KANSAS CITY MO
64111-5961
US

IV. Provider business mailing address

PO BOX 504407
SAINT LOUIS MO
63150-4407
US

V. Phone/Fax

Practice location:
  • Phone: 816-932-2307
  • Fax:
Mailing address:
  • Phone: 816-932-7940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberR5C04
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0418805
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberR5C04
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: