Basic Information
| Provider Information | |||||||||
| NPI: | 1609996412 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | AGUAYO | ||||||||
| FirstName: | PABLO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21420 W 59TH ST | ||||||||
| Address2: | |||||||||
| City: | SHAWNEE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662188412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9134224355 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2401 GILLHAM RD | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641084619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162343000 | ||||||||
| FaxNumber: | 8163029939 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2007 | ||||||||
| LastUpdateDate: | 02/04/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 2007018560 | MO | Y | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 04-32690 | KS | N | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.