Provider Demographics
NPI:1164913240
Name:DEARMON, SAMANTHA (DO)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:DEARMON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 OAK ST APT 241
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-2958
Mailing Address - Country:US
Mailing Address - Phone:417-693-0304
Mailing Address - Fax:
Practice Address - Street 1:17065 S OUTER RD
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-2165
Practice Address - Country:US
Practice Address - Phone:417-693-0304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021030125207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine