=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952574907
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELANIE DOERFLINGER GLENN M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2008
-----------------------------------------------------
Last Update Date | 08/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 402 N KEENE ST STE 101
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65201-6986
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-882-1515
-----------------------------------------------------
Fax | 573-884-0070
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 843966
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64184-3966
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-884-3300
-----------------------------------------------------
Fax | 573-884-0943
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | 2025033284
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | 04-36541
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2084N0008X
-----------------------------------------------------
Taxonomy Name | Neuromuscular Medicine (Psychiatry & Neurology) Physician
-----------------------------------------------------
License Number | 2025033284
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------