MEDICARE: DR. JOY A WEYDERT M.D.

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	208000000X	Pediatrics Physician	2002029455	MO
2	208000000X	Pediatrics Physician	04-34064	KS

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689623183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOY A WEYDERT M.D.

Provider Business Mailing Address
First Line	:	3901 RAINBOW BLVD
Second Line	:	MAIL STOP 4004
City	:	KANSAS CITY
State	:	KS
Zip	:	66103-2937
Country	:	US
Telephone Number	:	913-588-6364
Fax Number	:	913-588-6338

Provider Business Practice Location Address
First Line	:	3901 RAINBOW BLVD
Second Line	:	MAIL STOP 4004
City	:	KANSAS CITY
State	:	KS
Zip	:	66103-2937
Country	:	US
Telephone Number	:	913-588-6364
Fax Number	:	913-588-6338

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	03/09/2012

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Directions to “ DR. JOY A WEYDERT M.D.” Practice Location

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