Healthcare Provider Details

I. General information

NPI: 1588379952
Provider Name (Legal Business Name): JOSEPH L YEARGAIN DPM PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2023
Last Update Date: 12/07/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 NORTH BECKLEY AVE STE 456
DALLAS TX
75203-1201
US

IV. Provider business mailing address

3801 GASTON AVE STE 330
DALLAS TX
75246-1541
US

V. Phone/Fax

Practice location:
  • Phone: 214-824-3851
  • Fax: 214-824-3852
Mailing address:
  • Phone: 214-824-3851
  • Fax: 214-824-3852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: RYAN B STILLWELL
Title or Position: BILLING MANAGER
Credential:
Phone: 615-851-0144