Provider Demographics
NPI:1902868185
Name:VALENCIA, DANA (MD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:
Last Name:VALENCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 UNION AVE STE 1500
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-9408
Mailing Address - Country:US
Mailing Address - Phone:660-269-3191
Mailing Address - Fax:660-269-2943
Practice Address - Street 1:1513 UNION AVE STE 1500
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-9408
Practice Address - Country:US
Practice Address - Phone:660-263-0524
Practice Address - Fax:660-263-0595
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004007012207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209155506Medicaid
MOP00127492OtherMEDICARE RAILROAD
MO918541272Medicare PIN
MOP00127492OtherMEDICARE RAILROAD