Provider Demographics
NPI:1083610539
Name:ARNETT, GWENDOLYN (MD)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:
Last Name:ARNETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 504407
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-4407
Mailing Address - Country:US
Mailing Address - Phone:816-932-7940
Mailing Address - Fax:
Practice Address - Street 1:4321 WASHINGTON ST
Practice Address - Street 2:STE 1000
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5961
Practice Address - Country:US
Practice Address - Phone:816-932-2307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04188052085R0202X
MOR5C042085B0100X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100153570BMedicaid
KSP00152870OtherRR MEDICARE
KS2050520001Medicaid
MO300089670OtherRR MEDICARE
MOP00152851OtherRR MEDICARE
MO202351714Medicaid
MO202351772Medicaid
MO300089670OtherRR MEDICARE
MOP00152851OtherRR MEDICARE
KS100153570BMedicaid
MO202351714Medicaid
MOP00152851Medicare PIN
MO300089670Medicare PIN
KSE54730Medicare UPIN
KSP00152870Medicare PIN
MOK676154Medicare PIN
KSD086154Medicare ID - Type UnspecifiedKS/MO