Healthcare Provider Details

I. General information

NPI: 1023089349
Provider Name (Legal Business Name): QUINTIN LEE COKINGTIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 NE TUDOR RD
LEES SUMMIT MO
64086-5696
US

IV. Provider business mailing address

290 NE TUDOR RD
LEES SUMMIT MO
64086-5696
US

V. Phone/Fax

Practice location:
  • Phone: 816-524-5522
  • Fax: 816-875-2598
Mailing address:
  • Phone: 816-478-4200
  • Fax: 816-875-2597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberR9G23
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number04-24934
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberR9G23
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberR9G23
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: