Provider Demographics
NPI:1376589804
Name:D'AMOUR, TROY RICHARD (DO)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:RICHARD
Last Name:D'AMOUR
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:PO BOX 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-3810
Mailing Address - Country:US
Mailing Address - Phone:417-347-4662
Mailing Address - Fax:
Practice Address - Street 1:3202 MCINTOSH CIR STE 301
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3686
Practice Address - Country:US
Practice Address - Phone:417-347-8430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002010040207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO245826003Medicaid
MO157590OtherANTHEM
080183943OtherRR MEDICARE
MO245826003Medicaid
KS100420590AMedicaid
MO245826003Medicaid
H60330Medicare UPIN