Healthcare Provider Details

I. General information

NPI: 1568103224
Provider Name (Legal Business Name): CODY WAYNE DORTON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 HOLMES ST
KANSAS CITY MO
64108-2677
US

IV. Provider business mailing address

2301 HOLMES ST
KANSAS CITY MO
64108-2677
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-4175
  • Fax: 816-404-0003
Mailing address:
  • Phone: 816-404-4175
  • Fax: 816-404-0003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: