Healthcare Provider Details

I. General information

NPI: 1417029141
Provider Name (Legal Business Name): JOSEPH DOUGLAS YEAKEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 COUNTY RD 36
LEADVILLE CO
80461
US

IV. Provider business mailing address

PO BOX 943 1760 COUNTY RD 36
LEADVILLE CO
80461-0943
US

V. Phone/Fax

Practice location:
  • Phone: 719-293-4897
  • Fax:
Mailing address:
  • Phone: 719-293-4897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOH35048052
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDR - 32388
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOH350H48052
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: