Provider Demographics
NPI:1649241282
Name:YOCUM, RUSSELL STEWART (DO)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:STEWART
Last Name:YOCUM
Suffix:
Gender:M
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:9411 N OAK TRFY
Mailing Address - Street 2:SUITE LL1
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-2262
Mailing Address - Country:US
Mailing Address - Phone:816-436-7072
Mailing Address - Fax:816-436-2743
Practice Address - Street 1:2600 RUNNING HORSE ROAD
Practice Address - Street 2:
Practice Address - City:PLATTE CITY
Practice Address - State:MO
Practice Address - Zip Code:64079-9761
Practice Address - Country:US
Practice Address - Phone:816-858-2200
Practice Address - Fax:816-858-3611
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR3J21207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO242638203Medicaid
080147120OtherRAILROAD MEDICARE
14730013OtherBCBS OF KC INDIVIDUAL #
080147120OtherRAILROAD MEDICARE
J970347Medicare PIN