Provider Demographics
NPI:1972094647
Name:CONCANNON, TYLER (MD)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:CONCANNON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4321 WASHINGTON ST STE 1200
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-5905
Mailing Address - Country:US
Mailing Address - Phone:816-932-2932
Mailing Address - Fax:816-932-5491
Practice Address - Street 1:4321 WASHINGTON ST STE 1200
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5905
Practice Address - Country:US
Practice Address - Phone:816-932-2932
Practice Address - Fax:816-932-5491
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS94-09558207L00000X
MO2023029524207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology