Individual
JUSTIN A COOGLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2401 GILLHAM RD, KANSAS CITY, MO 64108-4619
(816) 234-3000
Mailing address
2401 GILLHAM RD, ATTN PROVIDER ENROLLMENT DEPT, KANSAS CITY, MO 64108-4619
(816) 701-5200
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
04-49494
KS
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
2021032815
MO
Other
Enumeration date
04/06/2019
Last updated
03/10/2026
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