Healthcare Provider Details

I. General information

NPI: 1750721254
Provider Name (Legal Business Name): THOMAS STEVEN YANGER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 SHOAL CREEK BLVD STE 130W
AUSTIN TX
78757-1040
US

IV. Provider business mailing address

2 TRANSAM PLAZA DR STE 410
OAKBROOK TERRACE IL
60181-4823
US

V. Phone/Fax

Practice location:
  • Phone: 512-407-8880
  • Fax:
Mailing address:
  • Phone: 866-259-1631
  • Fax: 855-618-2629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.142988
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberBP10047018
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: