Provider Demographics
NPI:1790760411
Name:YANNUCCI, JOHN J II (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:YANNUCCI
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:29 NW 1ST LN
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:MO
Mailing Address - Zip Code:64759-8105
Mailing Address - Country:US
Mailing Address - Phone:417-681-5248
Mailing Address - Fax:417-681-5748
Practice Address - Street 1:29 NW 1ST LN
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:MO
Practice Address - Zip Code:64759
Practice Address - Country:US
Practice Address - Phone:417-681-5100
Practice Address - Fax:417-681-5510
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2019-08-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME92786207Q00000X
MO2018034961207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI3922YMedicare UPIN