Healthcare Provider Details

I. General information

NPI: 1306866025
Provider Name (Legal Business Name): MARY E MACNAUGHTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 GLENN HENDREN DR
LIBERTY MO
64068-9625
US

IV. Provider business mailing address

9212 NIEMAN RD
OVERLAND PARK KS
66214-1868
US

V. Phone/Fax

Practice location:
  • Phone: 816-407-2038
  • Fax: 816-792-7135
Mailing address:
  • Phone: 913-599-6777
  • Fax: 913-599-3955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberR1P96
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: