Healthcare Provider Details

I. General information

NPI: 1750349874
Provider Name (Legal Business Name): RAM CHANDRA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 01/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 N 4TH ST STE B
ODESSA MO
64076-1646
US

IV. Provider business mailing address

408 N 4TH ST STE B
ODESSA MO
64076-1646
US

V. Phone/Fax

Practice location:
  • Phone: 816-633-1630
  • Fax: 816-633-1637
Mailing address:
  • Phone: 816-633-1630
  • Fax: 816-633-1637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number105321
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number105321
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: