Healthcare Provider Details

I. General information

NPI: 1558466458
Provider Name (Legal Business Name): WILLIAM ROBERT DAILEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 3RD ST
OSCEOLA MO
64776-2934
US

IV. Provider business mailing address

1602 N 2ND ST
CLINTON MO
64735-1192
US

V. Phone/Fax

Practice location:
  • Phone: 417-646-2134
  • Fax:
Mailing address:
  • Phone: 660-885-8171
  • Fax: 660-647-2160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2007035377
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: