Healthcare Provider Details

I. General information

NPI: 1952563215
Provider Name (Legal Business Name): LANDON DAVID HOUGH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 E RIVER BLUFF BLVD
OZARK MO
65721-8807
US

IV. Provider business mailing address

3050 E RIVER BLUFF BLVD
OZARK MO
65721-8807
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-5610
  • Fax:
Mailing address:
  • Phone: 417-820-7969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2008015788
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number20110039930
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number2011003930
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: