Healthcare Provider Details

I. General information

NPI: 1053314880
Provider Name (Legal Business Name): HENRY GEORGE YAVOREK JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE COMMERCE AVE
SELINSGROVE PA
17870-8920
US

IV. Provider business mailing address

1 COMMERCE AVE
SELINSGROVE PA
17870-7615
US

V. Phone/Fax

Practice location:
  • Phone: 570-374-9339
  • Fax: 570-347-7436
Mailing address:
  • Phone: 570-374-9339
  • Fax: 570-347-7436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD036651E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: