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General NPI Number Information
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NPI Number | 1033148721
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Entity Type | Individual
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Provider Name | JACK YANAKI MD
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Gender | Male
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 12/07/2007
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Provider Practice Location Address
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Address Line | 2021 N 12TH ST
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-2980
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Country | US
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Telephone | 970-242-0920
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Fax |
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Provider Business Mailing Address
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Address Line | 2754 COMPASS DR SUITE 300
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City | GRAND JUNCTION
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State | CO
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Zip | 81506-8714
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Country | US
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Telephone | 970-254-1686
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 27425
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License Number State | CO
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