Healthcare Provider Details

I. General information

NPI: 1134476732
Provider Name (Legal Business Name): CHRISTOPHER GEORGE YEARY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL CENTER DRIVE
HAZARD KY
41701
US

IV. Provider business mailing address

100 AIRPORT GARDENS RD
HAZARD KY
41701-9529
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-6782
  • Fax: 606-439-6879
Mailing address:
  • Phone: 606-439-6978
  • Fax: 606-439-6927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number5315056802
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberTP475
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: