Healthcare Provider Details

I. General information

NPI: 1942372388
Provider Name (Legal Business Name): JEFFREY DEAN YODER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2226 W ALTO RD
KOKOMO IN
46902-4840
US

IV. Provider business mailing address

2226 W ALTO RD
KOKOMO IN
46902-4840
US

V. Phone/Fax

Practice location:
  • Phone: 765-868-0313
  • Fax: 765-454-0554
Mailing address:
  • Phone: 765-868-0313
  • Fax: 765-454-0554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01050170
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: