Healthcare Provider Details

I. General information

NPI: 1003256959
Provider Name (Legal Business Name): GEORGE WESLEY ROODHOUSE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6675 HOLMES RD STE 360
KANSAS CITY MO
64131-1167
US

IV. Provider business mailing address

8300 N CHURCH RD
KANSAS CITY MO
64158-1104
US

V. Phone/Fax

Practice location:
  • Phone: 816-276-7650
  • Fax: 816-276-7992
Mailing address:
  • Phone: 816-407-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2013020349
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: