Healthcare Provider Details

I. General information

NPI: 1164555272
Provider Name (Legal Business Name): GREGORY SAINNOVAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL DR
LEBANON MO
65536-9210
US

IV. Provider business mailing address

100 HOSPITAL DR
LEBANON MO
65536-9210
US

V. Phone/Fax

Practice location:
  • Phone: 417-533-6100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2020029424
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number73579-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: