Basic Information
| Provider Information | |||||||||
| NPI: | 1790760411 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YANNUCCI | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 29 NW 1ST LN | ||||||||
| Address2: | |||||||||
| City: | LAMAR | ||||||||
| State: | MO | ||||||||
| PostalCode: | 647598105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4176815248 | ||||||||
| FaxNumber: | 4176815748 | ||||||||
| Practice Location | |||||||||
| Address1: | 29 NW 1ST LN | ||||||||
| Address2: | |||||||||
| City: | LAMAR | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4176815100 | ||||||||
| FaxNumber: | 4176815510 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2005 | ||||||||
| LastUpdateDate: | 08/06/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME92786 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 2018034961 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.