Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 15839 | OH |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 15839 | OH |
NPI | 1467522128 |
---|---|
Provider Name | Dr. Donald Yezerski |
First Address | Cleveland, OH 44130-4898 |
Second Address | Cleveland, OH 44130-4898 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2006 |
Last Update Date | 17/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T48597 | (02) |