Individual
DANIEL T PURDOM JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7900 LEES SUMMIT RD, KANSAS CITY, MO 64139-1236
(816) 404-7650
Mailing address
825 EUCLID AVE, KANSAS CITY, MO 64124-2323
(816) 474-4920
(816) 889-1847
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
04-36500
KS
207Q00000X
Family Medicine Physician
R8J68
MO
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
R8J68
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202683009
—
MO
01
—
C160996
MEDICARE B WHEATLANDS
MO
01
—
R8J68
LICENSE
MO
Enumeration date
04/18/2006
Last updated
09/19/2019
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