Healthcare Provider Details

I. General information

NPI: 1518078922
Provider Name (Legal Business Name): RICK YEAGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 MILLIS AVE
BOONVILLE IN
47601-2242
US

IV. Provider business mailing address

PO BOX 545
BOONVILLE IN
47601-0545
US

V. Phone/Fax

Practice location:
  • Phone: 812-897-4800
  • Fax: 812-897-7375
Mailing address:
  • Phone: 812-897-7171
  • Fax: 812-897-7375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number02000615A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: