Healthcare Provider Details

I. General information

NPI: 1114917366
Provider Name (Legal Business Name): EDGAR L HUNT JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 CLAY EDWARDS DR STE 420
NORTH KANSAS CITY MO
64116-3237
US

IV. Provider business mailing address

2750 CLAY EDWARDS DR STE 420
NORTH KANSAS CITY MO
64116-3237
US

V. Phone/Fax

Practice location:
  • Phone: 816-241-3338
  • Fax: 816-936-8118
Mailing address:
  • Phone: 816-241-3338
  • Fax: 816-936-8118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number2003008002
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number04-30166
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number36889
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number2003008002
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number04-30166
License Number StateKS
# 6
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number36889
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: