Healthcare Provider Details

I. General information

NPI: 1043203698
Provider Name (Legal Business Name): SCOTT E EVELOFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3470 NE RALPH POWELL RD SUITE B
LEES SUMMIT MO
64064-2336
US

IV. Provider business mailing address

3470 NE RALPH POWELL RD SUITE B
LEES SUMMIT MO
64064-2336
US

V. Phone/Fax

Practice location:
  • Phone: 913-498-3003
  • Fax: 913-341-5958
Mailing address:
  • Phone: 913-498-3003
  • Fax: 913-341-5958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number106596
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number0425096
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number35879
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25096
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: