Healthcare Provider Details

I. General information

NPI: 1336127109
Provider Name (Legal Business Name): MARK ORLAND SCOTT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 05/20/2022
Certification Date: 05/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9229 WARD PKWY STE 380
KANSAS CITY MO
64114-5471
US

IV. Provider business mailing address

14713 CONNELL ST
OVERLAND PARK KS
66221-9674
US

V. Phone/Fax

Practice location:
  • Phone: 816-319-4785
  • Fax:
Mailing address:
  • Phone: 913-961-7465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0530787
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2004007009
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: