Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | 274988 | NY |
N | 207NS0135X | Procedural Dermatology | 0101245688 | VA |
N | 207NS0135X | Procedural Dermatology | MD451829 | PA |
NPI | 1093997686 |
---|---|
Provider Name | Dr. Christopher Brent Yelverton |
First Address | Rochester, NY 14617-5504 |
Second Address | Rochester, NY 14625-2660 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2007 |
Last Update Date | 26/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03406439 | (05) | NY |
FY4607240 | DEA NY (01) | NY |