Healthcare Provider Details

I. General information

NPI: 1992794101
Provider Name (Legal Business Name): JOHN E YERG II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5410 CONNECTICUT AVE NW SUITE 117
WASHINGTON DC
20015-2859
US

IV. Provider business mailing address

5410 CONNECTICUT AVE NW SUITE 117
WASHINGTON DC
20015-2859
US

V. Phone/Fax

Practice location:
  • Phone: 202-966-8868
  • Fax: 202-244-3071
Mailing address:
  • Phone: 202-966-8868
  • Fax: 202-244-3071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number15876
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberD33554
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: