Healthcare Provider Details

I. General information

NPI: 1558471896
Provider Name (Legal Business Name): THOMAS JOHN YEAGLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1429 N 6TH ST
TERRE HAUTE IN
47807-1037
US

IV. Provider business mailing address

221 S 6TH ST
TERRE HAUTE IN
47807-4214
US

V. Phone/Fax

Practice location:
  • Phone: 812-242-3115
  • Fax: 812-235-9580
Mailing address:
  • Phone: 812-242-3115
  • Fax: 812-235-9580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01057264A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: