Healthcare Provider Details

I. General information

NPI: 1568682722
Provider Name (Legal Business Name): JEREMIAH E. YERTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11600 W 2ND PL EMERGENCY DEPARTMENT
LAKEWOOD CO
80228-1527
US

IV. Provider business mailing address

2600 MILLER ST
BETHANY MO
64424-2701
US

V. Phone/Fax

Practice location:
  • Phone: 720-321-4161
  • Fax: 720-321-4165
Mailing address:
  • Phone: 660-425-2211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0434371
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number50325
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2014030363
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: