Healthcare Provider Details

I. General information

NPI: 1043236318
Provider Name (Legal Business Name): ROBERT THOMAS YAVORSKI JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 MOREHEAD MEDICAL DR 3RD FLOOR
CHARLOTTE NC
28204-2963
US

IV. Provider business mailing address

1025 MOREHEAD MEDICAL DR
CHARLOTTE NC
28204-2963
US

V. Phone/Fax

Practice location:
  • Phone: 704-355-4593
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number9600785
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: