Healthcare Provider Details

I. General information

NPI: 1053679167
Provider Name (Legal Business Name): AARON MATTHEW MAYER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 CLAY EDWARDS DR STE 500
NORTH KANSAS CITY MO
64116-3263
US

IV. Provider business mailing address

2700 CLAY EDWARDS DR STE 500
NORTH KANSAS CITY MO
64116-3263
US

V. Phone/Fax

Practice location:
  • Phone: 816-421-4115
  • Fax: 816-421-4152
Mailing address:
  • Phone: 816-421-4115
  • Fax: 816-421-4152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2015010935
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: