Healthcare Provider Details

I. General information

NPI: 1528097938
Provider Name (Legal Business Name): RICK L YODER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 WESTFIELD DR STE 1
ARCHBOLD OH
43502-1005
US

IV. Provider business mailing address

11109 PARKVIEW PLAZA DR # 117
FORT WAYNE IN
46845-1701
US

V. Phone/Fax

Practice location:
  • Phone: 419-445-2015
  • Fax: 419-445-8102
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35-073458
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: