Provider Demographics
NPI:1992891303
Name:GJONI, DAUT S (MD)
Entity type:Individual
Prefix:DR
First Name:DAUT
Middle Name:S
Last Name:GJONI
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 1:1600 E EVERGREEN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CAMERON
Mailing Address - State:MO
Mailing Address - Zip Code:64429-2400
Mailing Address - Country:US
Mailing Address - Phone:816-649-0500
Mailing Address - Fax:816-649-0049
Practice Address - Street 1:1600 E EVERGREEN ST
Practice Address - Street 2:SUITE A
Practice Address - City:CAMERON
Practice Address - State:MO
Practice Address - Zip Code:64429-2400
Practice Address - Country:US
Practice Address - Phone:816-649-0500
Practice Address - Fax:816-649-0049
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD11432207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO27544011OtherBLUE CROSS BLUE SHIELD
MO203949102Medicaid
MO27544011OtherBLUE CROSS BLUE SHIELD