Healthcare Provider Details

I. General information

NPI: 1538150222
Provider Name (Legal Business Name): YVONNE M PRINCE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35629 HIGHWAY 72 BLDG II
SALEM MO
65560-7217
US

IV. Provider business mailing address

PO BOX 69
SALEM MO
65560-0069
US

V. Phone/Fax

Practice location:
  • Phone: 573-729-6112
  • Fax: 573-729-4035
Mailing address:
  • Phone: 573-729-6112
  • Fax: 573-729-4035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number102233
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: