Provider Demographics
NPI:1902940869
Name:LAYUGAN, YVONNE MEDRANO (MD)
Entity Type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:MEDRANO
Last Name:LAYUGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:YVONNE
Other - Middle Name:PURISIMA
Other - Last Name:MEDRANO-LAYUGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2900 LEMAY FERRY ROAD, SUITE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125-3969
Mailing Address - Country:US
Mailing Address - Phone:314-416-1926
Mailing Address - Fax:314-416-1007
Practice Address - Street 1:2900 LEMAY FERRY ROAD, SUITE 200
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-3969
Practice Address - Country:US
Practice Address - Phone:314-416-1926
Practice Address - Fax:314-416-1007
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007021711207Q00000X
HI14160207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO329505442Medicare PIN