Basic Information
| Provider Information | |||||||||
| NPI: | 1619967718 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRECKENRIDGE | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2750 CLAY EDWARDS DR | ||||||||
| Address2: | SUITE 420 | ||||||||
| City: | NORTH KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641163237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162413338 | ||||||||
| FaxNumber: | 8169368118 | ||||||||
| Practice Location | |||||||||
| Address1: | 2750 CLAY EDWARDS DR | ||||||||
| Address2: | SUITE 420 | ||||||||
| City: | NORTH KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641163237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162413338 | ||||||||
| FaxNumber: | 8169368118 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZB0001X | R6A73 | MO | X | Allopathic & Osteopathic Physicians | Pathology | Blood Banking & Transfusion Medicine | 207ZB0001X | 0418569 | KS | X | Allopathic & Osteopathic Physicians | Pathology | Blood Banking & Transfusion Medicine | 207ZB0001X | MD12472 | HI | X | Allopathic & Osteopathic Physicians | Pathology | Blood Banking & Transfusion Medicine | 207ZB0001X | BRECR2 | NY | X | Allopathic & Osteopathic Physicians | Pathology | Blood Banking & Transfusion Medicine | 207ZM0300X | R6A73 | MO | X | Allopathic & Osteopathic Physicians | Pathology | Medical Microbiology | 207ZM0300X | 0418569 | KS | X | Allopathic & Osteopathic Physicians | Pathology | Medical Microbiology | 207ZM0300X | MD12472 | HI | X | Allopathic & Osteopathic Physicians | Pathology | Medical Microbiology | 207ZM0300X | BRECR2 | NY | X | Allopathic & Osteopathic Physicians | Pathology | Medical Microbiology | 207ZP0102X | R6A73 | MO | X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0102X | 0418569 | KS | X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0102X | MD12472 | HI | X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0102X | BRECR2 | NY | X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.