Healthcare Provider Details

I. General information

NPI: 1689625667
Provider Name (Legal Business Name): CHARLES FRANKLIN YEAGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 MEDICAL PARK DR BLDG 1 STE 102
MOBILE AL
36693-3318
US

IV. Provider business mailing address

5320 HIGHWAY 90 W
MOBILE AL
36619-4202
US

V. Phone/Fax

Practice location:
  • Phone: 251-665-8060
  • Fax: 251-665-8061
Mailing address:
  • Phone: 251-602-1667
  • Fax: 251-602-5660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number7542
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: