Healthcare Provider Details

I. General information

NPI: 1356317952
Provider Name (Legal Business Name): DWAYNE E JONES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 03/26/2018
Certification Date:
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: 913-642-4900
  • Fax: 913-381-0979
Mailing address:
  • Phone: 913-322-6370
  • Fax: 913-381-0979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number109157
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number109157
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: