Provider Demographics
NPI:1679674220
Name:MATTONI, JOHN A JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:MATTONI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8717 W 110TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2144
Mailing Address - Country:US
Mailing Address - Phone:913-428-2900
Mailing Address - Fax:913-428-2951
Practice Address - Street 1:19550 E 39TH ST S
Practice Address - Street 2:SUITE 100
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2303
Practice Address - Country:US
Practice Address - Phone:913-428-2900
Practice Address - Fax:913-428-2951
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2013-07-29
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Provider Licenses
StateLicense IDTaxonomies
MO108692207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208886614Medicaid
MO100180060BMedicaid
MO208886614Medicaid
MOG04462Medicare UPIN
MO100180060BMedicaid