Healthcare Provider Details

I. General information

NPI: 1467489450
Provider Name (Legal Business Name): STEVEN KORY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 W ELM ST
ROGERS AR
72758-4018
US

IV. Provider business mailing address

3600 S NATIONAL AVE
SPRINGFIELD MO
65807-7311
US

V. Phone/Fax

Practice location:
  • Phone: 479-427-7722
  • Fax: 479-427-7721
Mailing address:
  • Phone: 417-322-6622
  • Fax: 417-350-1935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number100076
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberE-4380
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number100076
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number100076
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberE-4380
License Number StateAR
# 6
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberE-4380
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: