Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 2007-01061 | NC |
Y | 207Q00000X | Family Doctor | MD167386 | OR |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | MD167386 | OR |
NPI | 1669586442 |
---|---|
Provider Name | Jerry Yale JR. |
First Address | Woodburn, OR 97071-9060 |
Second Address | Woodburn, OR 97071-9060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 30/06/2021 |