Healthcare Provider Details

I. General information

NPI: 1922471200
Provider Name (Legal Business Name): DHP OF MISSOURI PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MERCY WAY STE 430
JOPLIN MO
64804-4524
US

IV. Provider business mailing address

5870 HIATUS RD STE 200
TAMARAC FL
33321-6424
US

V. Phone/Fax

Practice location:
  • Phone: 417-556-2278
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: RANDAL DABBS
Title or Position: PRESIDENT
Credential: MD
Phone: 865-293-5210