Healthcare Provider Details

I. General information

NPI: 1306049010
Provider Name (Legal Business Name): MOLLY BEA MENSER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 10/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 NW PLATTE RD SUITE 120
RIVERSIDE MO
64150-9613
US

IV. Provider business mailing address

221 W 48TH ST #1507
KANSAS CITY MO
64112-2680
US

V. Phone/Fax

Practice location:
  • Phone: 816-472-0400
  • Fax: 816-472-0813
Mailing address:
  • Phone: 913-956-9909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2011009214
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: