MEDICARE: DR. MARDONIO JESUS YAP M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	30508	MO
2	208600000X	Surgery Physician	30508	MO

General Provider Information

NPI Number	:	1548495641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARDONIO JESUS YAP M.D.

Provider Business Mailing Address
First Line	:	2010 GRECIAN WAY CT
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-1607
Country	:	US
Telephone Number	:	314-965-3915
Fax Number	:

Provider Business Practice Location Address
First Line	:	2010 GRECIAN WAY CT
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-1607
Country	:	US
Telephone Number	:	314-965-3915
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2009
Last Update Date	:	05/19/2009

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