Healthcare Provider Details

I. General information

NPI: 1720427834
Provider Name (Legal Business Name): JOSHUA A YEARY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1446 DR THOMAS WALKER RD
EWING VA
24248-8307
US

IV. Provider business mailing address

1446 DR THOMAS WALKER RD
EWING VA
24248-8307
US

V. Phone/Fax

Practice location:
  • Phone: 276-445-4826
  • Fax: 276-546-9702
Mailing address:
  • Phone: 276-445-4826
  • Fax: 276-546-9702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102204089
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: