Healthcare Provider Details

I. General information

NPI: 1851031231
Provider Name (Legal Business Name): PETER JONATHAN YEAGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 E MANSFIELD ST
BUCYRUS OH
44820-1960
US

IV. Provider business mailing address

700 N COLUMBUS ST
CRESTLINE OH
44827-1455
US

V. Phone/Fax

Practice location:
  • Phone: 419-563-0300
  • Fax: 419-563-0500
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.153472
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: