Healthcare Provider Details

I. General information

NPI: 1457424608
Provider Name (Legal Business Name): MELVIN A YARLOTT JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 8TH AVE NE
HAZEN ND
58545-4637
US

IV. Provider business mailing address

510 8TH AVE NE
HAZEN ND
58545-4637
US

V. Phone/Fax

Practice location:
  • Phone: 701-748-2225
  • Fax: 701-748-5757
Mailing address:
  • Phone: 701-748-2225
  • Fax: 701-748-5757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number6615
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: