Healthcare Provider Details

I. General information

NPI: 1386617983
Provider Name (Legal Business Name): DAVID LEE YEAGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

346 POMFRET ST
PUTNAM CT
06260-1871
US

IV. Provider business mailing address

PO BOX 591
PUTNAM CT
06260-0591
US

V. Phone/Fax

Practice location:
  • Phone: 860-928-0815
  • Fax: 860-928-4514
Mailing address:
  • Phone: 860-928-0815
  • Fax: 860-928-4514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number016964
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: