Healthcare Provider Details

I. General information

NPI: 1629224357
Provider Name (Legal Business Name): VINAY GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 N RIVERSIDE RD STE 200
SAINT JOSEPH MO
64507-2566
US

IV. Provider business mailing address

5301 FARAON ST STE 120
SAINT JOSEPH MO
64506-3512
US

V. Phone/Fax

Practice location:
  • Phone: 816-271-1301
  • Fax: 816-271-1302
Mailing address:
  • Phone: 816-271-1301
  • Fax: 816-271-1302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number04-39031
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number2016015076
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: