Healthcare Provider Details

I. General information

NPI: 1154562072
Provider Name (Legal Business Name): JOSHUA MICHAEL MOUROT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2009
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 CLAY EDWARDS DR STE 600
NORTH KANSAS CITY MO
64116-3274
US

IV. Provider business mailing address

2790 CLAY EDWARDS DR STE 625
NORTH KANSAS CITY MO
64116-3278
US

V. Phone/Fax

Practice location:
  • Phone: 816-691-5048
  • Fax: 816-346-7039
Mailing address:
  • Phone: 816-455-3990
  • Fax: 816-455-5351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2020019650
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: