Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 35069408 | OH |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 35069408 | OH |
NPI | 1548252901 |
---|---|
Provider Name | Joel Yeasting |
First Address | Luckey, OH 43443 |
Second Address | Perrysburg, OH 43551-3429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2005 |
Last Update Date | 26/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000322654 | ANTHEM (01) | OH |
2040197 | (05) | OH |
G45367 | (02) |