Healthcare Provider Details

I. General information

NPI: 1922003219
Provider Name (Legal Business Name): MATTHEW BRIAN YOAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 01/10/2021
Certification Date: 01/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MATTHEW ST SUITE B-1
MARIETTA OH
45750-1644
US

IV. Provider business mailing address

PO BOX 449
MARIETTA OH
45750-0449
US

V. Phone/Fax

Practice location:
  • Phone: 740-376-5501
  • Fax: 740-376-5506
Mailing address:
  • Phone: 740-374-4500
  • Fax: 740-374-5887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number20854
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number35085183
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: