Healthcare Provider Details

I. General information

NPI: 1477558088
Provider Name (Legal Business Name): MARK ALAN YARBOROUGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 02/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DOCTORS PARK
ASHEVILLE NC
28801-4500
US

IV. Provider business mailing address

2234 COLONIAL BLVD ATTN: PAYER CONTRACTING & RELATIONS
FORT MYERS FL
33907-1412
US

V. Phone/Fax

Practice location:
  • Phone: 828-253-5314
  • Fax: 828-254-5216
Mailing address:
  • Phone: 239-931-7342
  • Fax: 239-931-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number32452
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: