Healthcare Provider Details

I. General information

NPI: 1558465237
Provider Name (Legal Business Name): VINCENT MARK YAVOREK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6032 WOODVINE RISE
CANANDAIGUA NY
14424-8277
US

IV. Provider business mailing address

6032 WOODVINE RISE
CANANDAIGUA NY
14424-8277
US

V. Phone/Fax

Practice location:
  • Phone: 585-202-5022
  • Fax:
Mailing address:
  • Phone: 585-202-5022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number195888
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: