MEDICARE: GWENDOLYN ARNETT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	0418805	KS
2	2085B0100X	Body Imaging Physician	R5C04	MO
3	2085R0202X	Diagnostic Radiology Physician	R5C04	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00152870	OTHER	KS	RR MEDICARE
4	300089670	OTHER	MO	RR MEDICARE
5	P00152851	OTHER	MO	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083610539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWENDOLYN ARNETT MD

Provider Business Mailing Address
First Line	:	PO BOX 504407
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63150-4407
Country	:	US
Telephone Number	:	816-932-7940
Fax Number	:

Provider Business Practice Location Address
First Line	:	4321 WASHINGTON ST
Second Line	:	STE 1000
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-5961
Country	:	US
Telephone Number	:	816-932-2307
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	11/02/2012

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Directions to “ GWENDOLYN ARNETT MD” Practice Location

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