Healthcare Provider Details

I. General information

NPI: 1417060484
Provider Name (Legal Business Name): BARBARA ANN YEAGER DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1456 PARK AVE W
MANSFIELD OH
44906-2700
US

IV. Provider business mailing address

48 OTTERBEIN DR
LEXINGTON OH
44904-9700
US

V. Phone/Fax

Practice location:
  • Phone: 419-529-4602
  • Fax: 419-529-4664
Mailing address:
  • Phone: 419-884-2637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36-00-3297-Y
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: