Provider Demographics
NPI:1942649538
Name:DEMARCO, VINCENT (DO)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:DEMARCO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2406 SE 5TH TER
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-1067
Mailing Address - Country:US
Mailing Address - Phone:816-265-9270
Mailing Address - Fax:816-265-9277
Practice Address - Street 1:1604 NW MOCK AVE STE B
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-3123
Practice Address - Country:US
Practice Address - Phone:816-265-9270
Practice Address - Fax:816-265-9270
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016007359207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine