Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MD0000029062 | TN |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | E-9864 | AR |
NPI | 1063483055 |
---|---|
Provider Name | David Erik Yakin |
First Address | Fayetteville, AR 72703-6398 |
Second Address | Fayetteville, AR 72703-6398 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 21/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3812123 | (05) | TN |
G50766 | (02) | TN |