MEDICARE: DR. MOLLY BEA MENSER D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	2011009214	MO

General Provider Information

NPI Number	:	1306049010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOLLY BEA MENSER D.O.

Provider Business Mailing Address
First Line	:	221 W 48TH ST
Second Line	:	#1507
City	:	KANSAS CITY
State	:	MO
Zip	:	64112-2680
Country	:	US
Telephone Number	:	913-956-9909
Fax Number	:

Provider Business Practice Location Address
First Line	:	1805 NW PLATTE RD
Second Line	:	SUITE 120
City	:	RIVERSIDE
State	:	MO
Zip	:	64150-9613
Country	:	US
Telephone Number	:	816-472-0400
Fax Number	:	816-472-0813

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2007
Last Update Date	:	10/01/2013

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