Provider Demographics
NPI:1558330878
Name:CADY, ROGER KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:KENNETH
Last Name:CADY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:631 RIVERVIEW RD
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-7570
Mailing Address - Country:US
Mailing Address - Phone:417-724-8676
Mailing Address - Fax:417-890-8827
Practice Address - Street 1:3805 S KANSAS EXPY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-6988
Practice Address - Country:US
Practice Address - Phone:417-890-7888
Practice Address - Fax:417-890-8827
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8F67207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
001014842Medicare ID - Type Unspecified
MOE34316Medicare UPIN