Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 35-075267 | OH |
N | 207V00000X | Obstetrician & Gynecologist | 4301059625 | MI |
N | 207V00000X | Obstetrician & Gynecologist | S6330 | TX |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 35-075267 | OH |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 4301059625 | MI |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | S6330 | TX |
NPI | 1235164476 |
---|---|
Provider Name | Jerome L Yaklic |
First Address | Galveston, TX 77555-5303 |
Second Address | Galveston, TX 77555-2722 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 17/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1603210171 | BCBSM (01) | MI |
4645433 | (05) | MI |
G89707 | (02) |