Healthcare Provider Details

I. General information

NPI: 1659332948
Provider Name (Legal Business Name): ROBERT FRANK YACAVONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2376 CYPRESS CIRCLE, STE 203
CONWAY SC
29526-8994
US

IV. Provider business mailing address

300 SINGLETON RIDGE ROAD ATT PATIENT BILLING
CONWAY SC
29526-9142
US

V. Phone/Fax

Practice location:
  • Phone: 843-347-6038
  • Fax:
Mailing address:
  • Phone: 843-234-6995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number88795
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: