Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 2013020349 | MO |
NPI | 1003256959 |
---|---|
Provider Name | George Wesley Roodhouse |
First Address | Kansas City, MO 64158-1104 |
Second Address | Kansas City, MO 64131-1167 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2013 |
Last Update Date | 05/07/2016 |