Healthcare Provider Details

I. General information

NPI: 1811049307
Provider Name (Legal Business Name): JOHN V YACONO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 DRESSER CT
RALEIGH NC
27609-7323
US

IV. Provider business mailing address

1502 W NC HIGHWAY 54 STE 103
DURHAM NC
27707-5572
US

V. Phone/Fax

Practice location:
  • Phone: 919-792-3930
  • Fax: 855-251-4289
Mailing address:
  • Phone: 919-354-0840
  • Fax: 919-908-8167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number9601110
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: