Healthcare Provider Details

I. General information

NPI: 1588821979
Provider Name (Legal Business Name): JASON ANDERSON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 CARONDELET DR STE 301
KANSAS CITY MO
64114-4823
US

IV. Provider business mailing address

1010 CARONDELET DR STE 301
KANSAS CITY MO
64114-4823
US

V. Phone/Fax

Practice location:
  • Phone: 816-943-1111
  • Fax:
Mailing address:
  • Phone: 816-943-1111
  • Fax: 913-780-4834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number000868
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number216
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number216
License Number StateSD
# 4
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2021033439
License Number StateMO
# 5
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number12-00473
License Number StateKS
# 6
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number337
License Number StateNE
# 7
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number12-00473
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: