Healthcare Provider Details

I. General information

NPI: 1295700870
Provider Name (Legal Business Name): DR. BLANE WESLEY YELTON JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 OLD LEXINGTON RD
THOMASVILLE NC
27360-3428
US

IV. Provider business mailing address

211 OLD LEXINGTON RD
THOMASVILLE NC
27360-3428
US

V. Phone/Fax

Practice location:
  • Phone: 336-472-1191
  • Fax: 336-472-1208
Mailing address:
  • Phone: 336-472-1191
  • Fax: 336-472-1208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number17459
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: