Healthcare Provider Details

I. General information

NPI: 1487616058
Provider Name (Legal Business Name): SCOTT C COZAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2529 GLENN HENDREN DR SUITE G40
LIBERTY MO
64068-9625
US

IV. Provider business mailing address

6601 WINCHESTER AVE SUITE 230
KANSAS CITY MO
64133-4677
US

V. Phone/Fax

Practice location:
  • Phone: 816-415-2147
  • Fax: 816-415-2158
Mailing address:
  • Phone: 816-313-2677
  • Fax: 816-313-6000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberR3J99
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number04-22900
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: