Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 118183 | MO |
NPI | 1104861103 |
---|---|
Provider Name | Cherylon A Yarosh |
First Address | Joplin, MO 64803 |
Second Address | Joplin, MO 64804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2006 |
Last Update Date | 19/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
125812 | ANTHEM (01) | MO |
G92358 | (02) | |
P00116403 | RR MEDICARE (01) |