Provider Demographics
NPI:1003256959
Name:ROODHOUSE, GEORGE WESLEY (DO)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:WESLEY
Last Name:ROODHOUSE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 N CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64158-1104
Mailing Address - Country:US
Mailing Address - Phone:816-407-2300
Mailing Address - Fax:
Practice Address - Street 1:6675 HOLMES RD STE 360
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-1167
Practice Address - Country:US
Practice Address - Phone:816-276-7650
Practice Address - Fax:816-276-7992
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013020349207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine