Provider Demographics
NPI:1487651931
Name:ROYLANCE, JEFFREY F (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:F
Last Name:ROYLANCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775
Mailing Address - Country:US
Mailing Address - Phone:417-256-2111
Mailing Address - Fax:
Practice Address - Street 1:805 KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775
Practice Address - Country:US
Practice Address - Phone:417-256-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003005877207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO599022307Medicaid
MO599022308Medicaid
MO208806307Medicaid
MO000014537Medicare ID - Type UnspecifiedCARE PROFESSIONAL
MO268904Medicare ID - Type UnspecifiedCARE RHC
MO990010596Medicare ID - Type UnspecifiedCARE INDIVIDUAL
MO599022307Medicaid