Healthcare Provider Details

I. General information

NPI: 1447247218
Provider Name (Legal Business Name): BONNIE K GOINS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 10/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 N RIVERSIDE RD #201
SAINT JOSEPH MO
64507-2559
US

IV. Provider business mailing address

902 N RIVERSIDE RD STE 201
SAINT JOSEPH MO
64507-2566
US

V. Phone/Fax

Practice location:
  • Phone: 816-271-7280
  • Fax: 816-271-1047
Mailing address:
  • Phone: 816-271-7280
  • Fax: 816-271-1047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number100270
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: