Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 1576 | TX |
Y | 222Z00000X | Podiatrist | 1576 | TX |
N | 224P00000X | Prosthetist | 1576 | TX |
NPI | 1033519277 |
---|---|
Provider Name | Russ Flinn Yeager |
First Address | Round Rock, TX 78681-5052 |
Second Address | Round Rock, TX 78681-5052 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2014 |
Last Update Date | 28/08/2014 |