Healthcare Provider Details

I. General information

NPI: 1235367608
Provider Name (Legal Business Name): ROBIN LESLIE DYSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROBIN LESLIE EDWARDS

II. Dates (important events)

Enumeration Date: 06/24/2009
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 NW BLUE PKWY
LEES SUMMIT MO
64086-5705
US

IV. Provider business mailing address

1425 NW BLUE PKWY
LEES SUMMIT MO
64086-5705
US

V. Phone/Fax

Practice location:
  • Phone: 816-524-5600
  • Fax:
Mailing address:
  • Phone: 816-524-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2011009243
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: