Healthcare Provider Details

I. General information

NPI: 1285670281
Provider Name (Legal Business Name): WILLIAM L. GUMMELT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 FARAON ST
SAINT JOSEPH MO
64506-3488
US

IV. Provider business mailing address

5325 FARAON ST
SAINT JOSEPH MO
64506-3488
US

V. Phone/Fax

Practice location:
  • Phone: 816-271-6122
  • Fax: 816-271-6019
Mailing address:
  • Phone: 816-271-6122
  • Fax: 816-271-6019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number112084
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: