Healthcare Provider Details

I. General information

NPI: 1679533392
Provider Name (Legal Business Name): RICHARD S TOON SR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MERCY WAY STE 310
JOPLIN MO
64804-4524
US

IV. Provider business mailing address

100 MERCY WAY STE 310
JOPLIN MO
64804-4524
US

V. Phone/Fax

Practice location:
  • Phone: 417-556-8600
  • Fax:
Mailing address:
  • Phone: 417-556-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number04-29783
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number0429783
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number0429783
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number2004034551
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: