Healthcare Provider Details

I. General information

NPI: 1780665901
Provider Name (Legal Business Name): DAVID BRIAN YABLONSKY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1181 STATE RT 157 SUITE 200
EDWARDSVILLE IL
62025
US

IV. Provider business mailing address

6810 STATE RT 162 BOX 215
MARYVILLE IL
62062-8501
US

V. Phone/Fax

Practice location:
  • Phone: 618-288-8850
  • Fax: 618-288-8943
Mailing address:
  • Phone: 618-391-6405
  • Fax: 618-288-4088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036115282
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: