Healthcare Provider Details

I. General information

NPI: 1578521936
Provider Name (Legal Business Name): ROBERT T YEAGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

964 W IDAHO AVE SNAKE RIVER RADIOLOGY PC
ONTARIO OR
97914-2111
US

IV. Provider business mailing address

964 W IDAHO AVE SNAKE RIVER RADIOLOGY PC
ONTARIO OR
97914-2111
US

V. Phone/Fax

Practice location:
  • Phone: 541-889-9545
  • Fax: 541-889-8376
Mailing address:
  • Phone: 541-889-9545
  • Fax: 541-889-8376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD21487
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: