Healthcare Provider Details

I. General information

NPI: 1184698201
Provider Name (Legal Business Name): JON YEARGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BIDDLE AVENUE SUITE 200
NEWARK DE
19702
US

IV. Provider business mailing address

PO BOX 30170
WILMINGTON DE
19805
US

V. Phone/Fax

Practice location:
  • Phone: 302-838-4750
  • Fax: 302-838-4755
Mailing address:
  • Phone: 302-838-4750
  • Fax: 302-838-4755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC1007394
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: