MEDICARE: DR. HENRY GEORGE YAVOREK JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MD036651E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053314880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRY GEORGE YAVOREK JR. MD

Provider Business Mailing Address
First Line	:	1 COMMERCE AVE
Second Line	:
City	:	SELINSGROVE
State	:	PA
Zip	:	17870-7615
Country	:	US
Telephone Number	:	570-374-9339
Fax Number	:	570-347-7436

Provider Business Practice Location Address
First Line	:	ONE COMMERCE AVE
Second Line	:
City	:	SELINSGROVE
State	:	PA
Zip	:	17870-8920
Country	:	US
Telephone Number	:	570-374-9339
Fax Number	:	570-347-7436

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	05/06/2008

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