Healthcare Provider Details

I. General information

NPI: 1194530089
Provider Name (Legal Business Name): DEREK R YODER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 LIBERTY VIEW LN
LYNCHBURG VA
24502-2291
US

IV. Provider business mailing address

10 SHORE LINE DR
LYNCHBURG VA
24501-5923
US

V. Phone/Fax

Practice location:
  • Phone: 434-592-6400
  • Fax:
Mailing address:
  • Phone: 434-316-2887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0116040721
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: