Healthcare Provider Details

I. General information

NPI: 1396730461
Provider Name (Legal Business Name): DANA H DUCKWORTH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 STATE ST
LEXINGTON MO
64067-1107
US

IV. Provider business mailing address

406 E ORCHARD ST
ODESSA MO
64076-1578
US

V. Phone/Fax

Practice location:
  • Phone: 660-259-2203
  • Fax: 660-259-6819
Mailing address:
  • Phone: 816-682-3887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR5B62
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO R5B62
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: