Healthcare Provider Details

I. General information

NPI: 1790760411
Provider Name (Legal Business Name): JOHN J YANNUCCI II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 NW 1ST LN
LAMAR MO
64759
US

IV. Provider business mailing address

29 NW 1ST LN
LAMAR MO
64759-8105
US

V. Phone/Fax

Practice location:
  • Phone: 417-681-5100
  • Fax: 417-681-5510
Mailing address:
  • Phone: 417-681-5248
  • Fax: 417-681-5748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME92786
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2018034961
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: