Provider Demographics
NPI:1649400375
Name:DOODY, DIAN LEA (MD)
Entity Type:Individual
Prefix:
First Name:DIAN
Middle Name:LEA
Last Name:DOODY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EMERALD WAY
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-5060
Mailing Address - Country:US
Mailing Address - Phone:417-623-1177
Mailing Address - Fax:
Practice Address - Street 1:1 EMERALD WAY
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-5060
Practice Address - Country:US
Practice Address - Phone:417-623-1177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3C73208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics