Provider Demographics
NPI:1881853158
Name:JAYARAO, MAYUR (MD, MSC)
Entity Type:Individual
Prefix:DR
First Name:MAYUR
Middle Name:
Last Name:JAYARAO
Suffix:
Gender:M
Credentials:MD, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 E PRIMROSE ST STE C
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4377
Mailing Address - Country:US
Mailing Address - Phone:417-882-1207
Mailing Address - Fax:417-881-7268
Practice Address - Street 1:3801 S NATIONAL AVE STE 700
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807
Practice Address - Country:US
Practice Address - Phone:417-885-3888
Practice Address - Fax:417-520-5959
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT207746207T00000X
RIMD15736207T00000X
FLME132344207T00000X
MO2018010679207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery