Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 2001001596 | MO |
NPI | 1245239797 |
---|---|
Provider Name | Dr. Jeffrey Paul Yannette |
First Address | Lees Summit, MO 64086-5705 |
Second Address | Lees Summit, MO 64082 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
29836011 | BCBSKC PROVIDER NUMBER (01) | KS |