Provider Demographics
NPI:1881662724
Name:SYLVARA, JOHN T (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:SYLVARA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S GEX ST
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MO
Mailing Address - Zip Code:63549-1243
Mailing Address - Country:US
Mailing Address - Phone:660-332-4312
Mailing Address - Fax:660-332-7996
Practice Address - Street 1:201 S GEX ST
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MO
Practice Address - Zip Code:63549-1243
Practice Address - Country:US
Practice Address - Phone:660-332-4312
Practice Address - Fax:660-332-7996
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101190207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO243370103Medicaid
MO546205588Medicare PIN
MO243370103Medicaid
MOF27954Medicare UPIN