Healthcare Provider Details

I. General information

NPI: 1184686719
Provider Name (Legal Business Name): SUSANNE CAROL YEAGLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 HEDGCOXE RD STE 120
PLANO TX
75025-3163
US

IV. Provider business mailing address

2100 HEDGCOXE RD STE 120
PLANO TX
75025-3163
US

V. Phone/Fax

Practice location:
  • Phone: 972-769-8443
  • Fax: 972-769-2395
Mailing address:
  • Phone: 972-769-8443
  • Fax: 972-769-2395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH5816
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: