Healthcare Provider Details

I. General information

NPI: 1265767909
Provider Name (Legal Business Name): MARTHA F YEARSLEY M.D. PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2009
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 DORBETT ST
JASPER IN
47546-2619
US

IV. Provider business mailing address

1005 DORBETT ST
JASPER IN
47546-2619
US

V. Phone/Fax

Practice location:
  • Phone: 812-482-5700
  • Fax: 812-481-1045
Mailing address:
  • Phone: 812-482-5700
  • Fax: 812-481-1045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01042841A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01042841A
License Number StateIN

VIII. Authorized Official

Name: DR. MARTHA YEARSLEY
Title or Position: OWNER
Credential: M.D.
Phone: 812-482-5700