Individual
JOHNNY GYEBI-ADU YAMOAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.FAAP
Contact information
Practice address
1701 LACEY ST, CAPE GIRARDEAU, MO 63701-5230
(573) 334-4822
Mailing address
2162 SUSSEX DR, CAPE GIRARDEAU, MO 63701-1883
(417) 619-0464
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
125050224
IL
207R00000X
Internal Medicine Physician
Primary
2009000147
MO
208000000X
Pediatrics Physician
125050244
IL
208000000X
Pediatrics Physician
2009000147
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
# PENDING
—
MO
05
—
036119750
—
IL
Enumeration date
05/19/2007
Last updated
06/13/2013
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