Healthcare Provider Details

I. General information

NPI: 1073530671
Provider Name (Legal Business Name): SUSAN M YEAGER DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 REDCLIFF DR STE 100
REDDING CA
96002-0167
US

IV. Provider business mailing address

1901 COOK ST
DYERSBURG TN
38024-1882
US

V. Phone/Fax

Practice location:
  • Phone: 731-286-2139
  • Fax:
Mailing address:
  • Phone: 731-885-0220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3136
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number820
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number80215
License Number StateMS
# 4
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE5322
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: