Individual
MR. DOUGLAS THANE ROMNEY CODY II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1115 ALASKA ST STE 214, WEST PLAINS, MO 65775-2014
(417) 505-7114
(417) 853-5302
Mailing address
PO BOX 1100, WEST PLAINS, MO 65775-1100
(417) 505-7114
(417) 853-5302
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
31264
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558328377
—
IA
01
—
2019029148
STATE LICENSE
MO
05
—
3141838
—
IA
01
—
P00449774
RR MC MSC
IA
Enumeration date
04/26/2006
Last updated
09/23/2019
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