Healthcare Provider Details

I. General information

NPI: 1295423846
Provider Name (Legal Business Name): JONATHAN DUANE BINGHAM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 S NATIONAL AVE STE 700
SPRINGFIELD MO
65807-5279
US

IV. Provider business mailing address

105 FAR WEST DR STE 100
SAINT JOSEPH MO
64506-3514
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-8817
  • Fax: 417-269-8744
Mailing address:
  • Phone: 816-271-8110
  • Fax: 816-271-8104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2024026911
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: