MEDICARE: DR. VLADISLAV L YEGANOV M.D.

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	2084P0800X	Psychiatry Physician	L8562	TX

General Provider Information

NPI Number	:	1538145792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VLADISLAV L YEGANOV M.D.

Provider Business Mailing Address
First Line	:	712 N WASHINGTON AVE
Second Line	:	SUITE 411
City	:	DALLAS
State	:	TX
Zip	:	75246-1619
Country	:	US
Telephone Number	:	214-824-9100
Fax Number	:	214-824-9101

Provider Business Practice Location Address
First Line	:	712 N WASHINGTON AVE
Second Line	:	SUITE 411
City	:	DALLAS
State	:	TX
Zip	:	75246-1619
Country	:	US
Telephone Number	:	214-824-9100
Fax Number	:	214-824-9101

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

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	10/10/2008

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