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General NPI Number Information
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NPI Number | 1346253580
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Entity Type | Individual
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Provider Name | JON ROBERT MATTSON DO
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Gender | Male
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 03/14/2023
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Provider Practice Location Address
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Address Line | 5830 NW BARRY RD
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City | KANSAS CITY
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State | MO
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Zip | 64154-2778
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Country | US
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Telephone | 816-880-6200
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Fax | 816-880-6206
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Provider Business Mailing Address
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Address Line | 5830 NW BARRY RD
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City | KANSAS CITY
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State | MO
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Zip | 64154-2778
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Country | US
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Telephone | 816-880-6200
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Fax | 816-880-6206
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 2000165578
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2000165578
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License Number State | MO
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