Healthcare Provider Details

I. General information

NPI: 1376751529
Provider Name (Legal Business Name): WALTER J YEE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2007
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7210 W MAIN ST
BELLEVILLE IL
62223-3038
US

IV. Provider business mailing address

7210 W MAIN ST
BELLEVILLE IL
62223-3038
US

V. Phone/Fax

Practice location:
  • Phone: 618-394-0712
  • Fax: 618-394-1346
Mailing address:
  • Phone: 618-394-0712
  • Fax: 618-394-1346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5101019561
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036-135855
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: