Healthcare Provider Details

I. General information

NPI: 1215425871
Provider Name (Legal Business Name): PHILLIP BOYD MANN JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2018
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 CARONDELET DR STE 100
KANSAS CITY MO
64114-4673
US

IV. Provider business mailing address

901 HEARTLAND RD
SAINT JOSEPH MO
64506-3460
US

V. Phone/Fax

Practice location:
  • Phone: 816-942-4500
  • Fax:
Mailing address:
  • Phone: 832-325-7280
  • Fax: 713-512-7104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number2023025695
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number2023025695
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: