Provider Demographics
NPI:1619927720
Name:POMEROY, BRANDON D (MD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:D
Last Name:POMEROY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8551 BLUEJACKET ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66214-1656
Mailing Address - Country:US
Mailing Address - Phone:913-341-7985
Mailing Address - Fax:913-341-7988
Practice Address - Street 1:4321 WASHINGTON ST
Practice Address - Street 2:SUITE 5300
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5961
Practice Address - Country:US
Practice Address - Phone:816-531-1234
Practice Address - Fax:816-531-0737
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-27485174400000X
MO2001023021174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100315140CMedicaid
MO205752603Medicaid
340019585OtherRR MEDICARE
MOJ71B229AMedicare PIN
MO205752603Medicaid
KS100315140CMedicaid