Healthcare Provider Details

I. General information

NPI: 1821171836
Provider Name (Legal Business Name): MARK YEAKLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7102 SHIPP RD
ROWLETT TX
75088-4226
US

IV. Provider business mailing address

7102 SHIPP RD
ROWLETT TX
75088-4226
US

V. Phone/Fax

Practice location:
  • Phone: 972-463-6890
  • Fax: 972-463-6890
Mailing address:
  • Phone: 972-463-6890
  • Fax: 972-463-6890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberE9469
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: