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Organization

C. TUCKER JOUSTRA FAMILY PRACTICE, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CLARENCE TUCKER JOUSTRA D.O. (PRESIDENT)
(417) 682-5508
Entity
Organization

Contact information

Practice address
805 GULF ST, LAMAR, MO 64759-1238
(417) 682-5508
(417) 682-5594
Mailing address
805 GULF ST, LAMAR, MO 64759-1238
(417) 682-5508
(417) 682-5594

Taxonomy

Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
R9G86
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
242426534
MO
Enumeration date
02/08/2010
Last updated
02/08/2010
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