Healthcare Provider Details

I. General information

NPI: 1285744458
Provider Name (Legal Business Name): DWAYNE JONES, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 CLAY EDWARDS DR
KANSAS CITY MO
64116-3276
US

IV. Provider business mailing address

2790 CLAY EDWARDS DR
KANSAS CITY MO
64116-3276
US

V. Phone/Fax

Practice location:
  • Phone: 913-647-4100
  • Fax: 913-647-4120
Mailing address:
  • Phone: 913-647-4100
  • Fax: 913-647-4120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number109157
License Number StateMO

VIII. Authorized Official

Name: DWAYNE E JONES
Title or Position: PRESIDENT
Credential: MD
Phone: 913-961-1744