Healthcare Provider Details

I. General information

NPI: 1316972763
Provider Name (Legal Business Name): BRIAN L YOST PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 HIGHWAY 25 N
BUFFALO MN
55313-1930
US

IV. Provider business mailing address

1700 HIGHWAY 25 N
BUFFALO MN
55313-1930
US

V. Phone/Fax

Practice location:
  • Phone: 763-682-1313
  • Fax:
Mailing address:
  • Phone: 763-682-1313
  • Fax: 763-581-9090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9331
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: