Provider Demographics
NPI:1184686487
Name:EARHART, TODD ROBERT (PA-C)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:ROBERT
Last Name:EARHART
Suffix:
Gender:M
Credentials:PA-C
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 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-884-4400
Practice Address - Fax:573-884-5994
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2022-09-14
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-08-06
Provider Licenses
StateLicense IDTaxonomies
MO2005002886363A00000X
MO2020018500363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q43650Medicare UPIN
000097320Medicare PIN