Healthcare Provider Details

I. General information

NPI: 1376531152
Provider Name (Legal Business Name): WILFRED W YEARGAN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 08/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 FAIRFAX PARK
TUSCALOOSA AL
35406-2806
US

IV. Provider business mailing address

1030 FAIRFAX PARK
TUSCALOOSA AL
35406-2806
US

V. Phone/Fax

Practice location:
  • Phone: 205-752-1584
  • Fax: 205-752-9987
Mailing address:
  • Phone: 205-752-1584
  • Fax: 205-752-9987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number3697
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: