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General NPI Number Information
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NPI Number | 1194796672
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Entity Type | Individual
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Provider Name | CARL CECIL YODER MD
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Gender | Male
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Dates
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Enumeration Date | 01/31/2006
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Last Update Date | 08/08/2012
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Provider Practice Location Address
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Address Line | 9040 REID ST
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City | JOINT BASE LEWIS MCCHORD
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State | WA
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Zip | 98431-1100
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Country | US
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Telephone | 253-968-0502
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Fax |
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Provider Business Mailing Address
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Address Line | 5116 84TH AVE W
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98467-1826
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Country | US
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Telephone | 253-565-6832
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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 | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number | 15540
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License Number State | OK
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