Healthcare Provider Details

I. General information

NPI: 1831712108
Provider Name (Legal Business Name): JUSTIN LYNN ORREN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 E 32ND ST
JOPLIN MO
64804-4034
US

IV. Provider business mailing address

PO BOX 3810
JOPLIN MO
64803-3810
US

V. Phone/Fax

Practice location:
  • Phone: 417-347-2273
  • Fax: 417-347-2277
Mailing address:
  • Phone: 417-347-4662
  • Fax: 417-347-9453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2023014385
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: