Healthcare Provider Details

I. General information

NPI: 1720093396
Provider Name (Legal Business Name): LUKE DOUGLAS PYRON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 07/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 HAZEL AVE
CARTHAGE MO
64836-3020
US

IV. Provider business mailing address

1615 HAZEL AVE
CARTHAGE MO
64836-3020
US

V. Phone/Fax

Practice location:
  • Phone: 417-359-8803
  • Fax: 417-359-8454
Mailing address:
  • Phone: 417-359-8803
  • Fax: 417-359-8454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2003016147
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: