Provider Demographics
NPI:1669457743
Name:GOSAL, JAGPAL S (MD)
Entity Type:Individual
Prefix:
First Name:JAGPAL
Middle Name:S
Last Name:GOSAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 116
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64013
Mailing Address - Country:US
Mailing Address - Phone:660-287-2956
Mailing Address - Fax:816-229-2341
Practice Address - Street 1:1912 NW COPPER OAKS CIR
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-8300
Practice Address - Country:US
Practice Address - Phone:660-829-3700
Practice Address - Fax:660-829-3701
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-12
Last Update Date:2019-06-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO1143292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209734532Medicaid
MOG77532Medicare UPIN