Provider Demographics
NPI:1740444728
Name:SELBY, ANDI J (DO)
Entity type:Individual
Prefix:
First Name:ANDI
Middle Name:J
Last Name:SELBY
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:ANDI
Other - Middle Name:J
Other - Last Name:LYNCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:202 E 50TH ST
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-4920
Mailing Address - Country:US
Mailing Address - Phone:417-556-3400
Mailing Address - Fax:417-556-3401
Practice Address - Street 1:202 E 50TH ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4920
Practice Address - Country:US
Practice Address - Phone:417-556-3400
Practice Address - Fax:417-556-3401
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016007045207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200632650AMedicaid
KS201136300AMedicaid
MO1740444728Medicaid
OK200632650AMedicaid