Healthcare Provider Details

I. General information

NPI: 1740521327
Provider Name (Legal Business Name): AMENYEDU P. ADOVOR D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: AMENYEDU ADOVOR

II. Dates (important events)

Enumeration Date: 03/07/2013
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 W 32ND ST
JOPLIN MO
64804-3503
US

IV. Provider business mailing address

PO BOX 3810
JOPLIN MO
64803-3810
US

V. Phone/Fax

Practice location:
  • Phone: 417-347-6611
  • Fax:
Mailing address:
  • Phone: 417-347-4662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberOS15878
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number05-51382
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberOS15878
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number2023025585
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: