Healthcare Provider Details

I. General information

NPI: 1386933109
Provider Name (Legal Business Name): MARK LOWELL YELDERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15800 MIDWAY RD
ADDISON TX
75001-4259
US

IV. Provider business mailing address

PO BOX 4432
MCCALL ID
83638-4432
US

V. Phone/Fax

Practice location:
  • Phone: 855-835-6337
  • Fax: 844-371-8990
Mailing address:
  • Phone: 214-952-3018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number1973
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: