Basic Information
| Provider Information | |||||||||
| NPI: | 1003256959 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROODHOUSE | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | WESLEY | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8300 N CHURCH RD | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641581104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164072300 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6675 HOLMES RD STE 360 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641311167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162767650 | ||||||||
| FaxNumber: | 8162767992 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2013 | ||||||||
| LastUpdateDate: | 07/05/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2013020349 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.