MEDICARE: JAGPAL S GOSAL 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	2084P0800X	Psychiatry Physician	114329	MO

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

General Provider Information

NPI Number	:	1669457743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAGPAL S GOSAL MD

Provider Business Mailing Address
First Line	:	PO BOX 116
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64013
Country	:	US
Telephone Number	:	660-287-2956
Fax Number	:	816-229-2341

Provider Business Practice Location Address
First Line	:	1912 NW COPPER OAKS CIR
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64015-8300
Country	:	US
Telephone Number	:	660-829-3700
Fax Number	:	660-829-3701

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

Provider Enumeration Date	:	12/12/2005
Last Update Date	:	06/29/2019

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