Healthcare Provider Details

I. General information

NPI: 1467362699
Provider Name (Legal Business Name): CHRISTOPHER DOUTY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 DR RUSSELL SMITH WAY
CARTHAGE MO
64836-7402
US

IV. Provider business mailing address

336 E GREYSTONE SQ
WEBB CITY MO
64870-9276
US

V. Phone/Fax

Practice location:
  • Phone: 417-358-8121
  • Fax:
Mailing address:
  • Phone: 626-652-2459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: