Healthcare Provider Details

I. General information

NPI: 1730766056
Provider Name (Legal Business Name): ANDREW DONALDSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MOSAIC CT STE 200
SAINT JOSEPH MO
64506-0015
US

IV. Provider business mailing address

101 MOSAIC CT STE 200
SAINT JOSEPH MO
64506-0015
US

V. Phone/Fax

Practice location:
  • Phone: 816-271-1350
  • Fax: 816-271-1355
Mailing address:
  • Phone: 816-271-1350
  • Fax: 816-271-1355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2024024464
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number2024024464
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: