Healthcare Provider Details

I. General information

NPI: 1548226541
Provider Name (Legal Business Name): RONY M ABOU-JAWDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 08/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 NO RIVERSIDE RD SUITE 200
ST JOSEPH MO
64507-2559
US

IV. Provider business mailing address

902 NO RIVERSIDE RD SUITE 200
ST JOSEPH MO
64507-2559
US

V. Phone/Fax

Practice location:
  • Phone: 816-271-1301
  • Fax: 816-271-1302
Mailing address:
  • Phone: 816-271-1301
  • Fax: 816-271-1302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number2005028540
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: