Healthcare Provider Details

I. General information

NPI: 1962361279
Provider Name (Legal Business Name): MICHAEL EUGENE AYRES R.T. (N)(CT)(MR)
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2026
Last Update Date: 01/21/2026
Certification Date: 01/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 S HIGHWAY 65
MARSHALL MO
65340-3702
US

IV. Provider business mailing address

2305 S HIGHWAY 65
MARSHALL MO
65340-3702
US

V. Phone/Fax

Practice location:
  • Phone: 660-886-7431
  • Fax:
Mailing address:
  • Phone: 660-886-7431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number417625
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: