Provider Demographics
NPI:1619967718
Name:BRECKENRIDGE, ROBERT L (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:BRECKENRIDGE
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:2750 CLAY EDWARDS DR
Mailing Address - Street 2:SUITE 420
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3237
Mailing Address - Country:US
Mailing Address - Phone:816-241-3338
Mailing Address - Fax:816-936-8118
Practice Address - Street 1:2750 CLAY EDWARDS DR
Practice Address - Street 2:SUITE 420
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3237
Practice Address - Country:US
Practice Address - Phone:816-241-3338
Practice Address - Fax:816-936-8118
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-28
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR6A73207ZB0001X, 207ZM0300X, 207ZP0102X
KS0418569207ZB0001X, 207ZM0300X, 207ZP0102X
HIMD12472207ZB0001X, 207ZM0300X, 207ZP0102X
NYBRECR2207ZB0001X, 207ZM0300X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
Not Answered207ZM0300XAllopathic & Osteopathic PhysiciansPathologyMedical Microbiology
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E94267Medicare UPIN