Healthcare Provider Details

I. General information

NPI: 1033603717
Provider Name (Legal Business Name): SAMUEL PALMER DUMONTIER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7450 KESSLER ST STE 204
MERRIAM KS
66204-2553
US

IV. Provider business mailing address

7450 KESSLER ST STE 204
MERRIAM KS
66204-2553
US

V. Phone/Fax

Practice location:
  • Phone: 913-632-9770
  • Fax: 913-632-9799
Mailing address:
  • Phone: 913-632-9770
  • Fax: 913-632-9799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR11316
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number05-50858
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: