MEDICARE: MR. THOMAS NATHAN SEXTON DPM

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	213E00000X	Podiatrist	12-00278	KS
2	213E00000X	Podiatrist	000576	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8338922	OTHER	MO	MISSOURI MEDICARE

General Provider Information

NPI Number	:	1841290624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS NATHAN SEXTON DPM

Provider Business Mailing Address
First Line	:	5601 NE ANTIOCH RD
Second Line	:	STE 7
City	:	GLADSTONE
State	:	MO
Zip	:	64119-2302
Country	:	US
Telephone Number	:	816-455-1155
Fax Number	:	816-455-1161

Provider Business Practice Location Address
First Line	:	5601 NE ANTIOCH RD
Second Line	:	STE 7
City	:	GLADSTONE
State	:	MO
Zip	:	64119-2302
Country	:	US
Telephone Number	:	816-455-1155
Fax Number	:	816-455-1161

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	07/08/2007

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