Healthcare Provider Details

I. General information

NPI: 1114964798
Provider Name (Legal Business Name): DENNIS M HANDLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 08/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17601 B HWY
BOONVILLE MO
65233-2839
US

IV. Provider business mailing address

PO BOX 88 17651 B. HIGHWAY
BOONVILLE MO
65233-0088
US

V. Phone/Fax

Practice location:
  • Phone: 660-882-2121
  • Fax: 660-882-7073
Mailing address:
  • Phone: 660-882-2121
  • Fax: 660-882-7073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMDR7966
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: