=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558328377
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DOUGLAS THANE ROMNEY CODY II MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2006
-----------------------------------------------------
Last Update Date | 09/23/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1115 ALASKA ST STE 214
-----------------------------------------------------
City | WEST PLAINS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65775-2014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-505-7114
-----------------------------------------------------
Fax | 417-853-5302
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1100
-----------------------------------------------------
City | WEST PLAINS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65775-1100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-505-7114
-----------------------------------------------------
Fax | 417-853-5302
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | 31264
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------