Healthcare Provider Details

I. General information

NPI: 1851474084
Provider Name (Legal Business Name): JOEL T. YERBY, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 OAKDALE RD
MODESTO CA
95355
US

IV. Provider business mailing address

817 COFFEE RD C3
MODESTO CA
95355
US

V. Phone/Fax

Practice location:
  • Phone: 209-572-2700
  • Fax: 209-572-0150
Mailing address:
  • Phone: 209-529-9603
  • Fax: 209-529-6610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG82323
License Number StateCA

VIII. Authorized Official

Name: JOEL TALBERT YERBY
Title or Position: PRESIDENT
Credential: MD
Phone: 209-529-9603