MEDICARE: YOAKUM COUNTY MEDICAL ASSOCIATES PLLC

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	208000000X	Pediatrics Physician
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1760653976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOAKUM COUNTY MEDICAL ASSOCIATES PLLC

Provider Business Mailing Address
First Line	:	PO BOX 2023
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76202-2023
Country	:	US
Telephone Number	:	940-384-6238
Fax Number	:

Provider Business Practice Location Address
First Line	:	412 MUSTANG DR
Second Line	:
City	:	DENVER CITY
State	:	TX
Zip	:	79323-2750
Country	:	US
Telephone Number	:	806-592-9501
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	SUSAN SOWDER
Credential	:
Telephone Number	:	940-384-6238

Provider Enumeration Date	:	03/14/2008
Last Update Date	:	10/17/2008

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