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General NPI Number Information
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NPI Number | 1841319928
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Entity Type | Individual
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Provider Name | JEANNE M DE MOTTE M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 02/06/2015
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Provider Practice Location Address
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Address Line | 904 WOLLARD BLVD.
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City | RICHMOND
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State | MO
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Zip | 64085
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Country | US
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Telephone | 816-470-5432
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Fax | 816-470-7343
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Provider Business Mailing Address
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Address Line | PO BOX 615
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City | RICHMOND
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State | MO
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Zip | 64085-0615
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Country | US
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Telephone | 816-615-1413
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Fax |
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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 | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number | 2002010572
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 2002010572
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2002010572
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License Number State | MO
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