Provider Demographics
NPI:1396722765
Name:YEOMAN, LANCE F (DO)
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:F
Last Name:YEOMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63902-0699
Mailing Address - Country:US
Mailing Address - Phone:573-686-4750
Mailing Address - Fax:573-686-4753
Practice Address - Street 1:225 PHYSICIANS PARK STE 203
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-3921
Practice Address - Country:US
Practice Address - Phone:573-686-4750
Practice Address - Fax:573-686-4753
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2008021956207N00000X
NC200700075207N00000X
WI30823021207N00000X
IA01955207N00000X
VA0102201530207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA1428Medicare Oscar/Certification
MOMA1428001Medicare Oscar/Certification
WV1811403000Medicaid