Healthcare Provider Details

I. General information

NPI: 1568432615
Provider Name (Legal Business Name): WEI YANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NORTHEAST IOWA PATHOLOGY ASSOCIATES, PC 1825 LOGAN AVENUE
WATERLOO IA
50703
US

IV. Provider business mailing address

P.O. BOX 957076
ST. LOUIS MO
63195-7076
US

V. Phone/Fax

Practice location:
  • Phone: 319-235-3679
  • Fax: 319-233-0722
Mailing address:
  • Phone: 347-817-7842
  • Fax: 866-379-7504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number35459
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: