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General NPI Number Information
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NPI Number | 1629371018
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Entity Type | Organization
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Legal Business Name | RICHARD L YELVERTON MD PA
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Dates
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Enumeration Date | 12/07/2010
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Last Update Date | 12/07/2010
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Provider Practice Location Address
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Address Line | 1040 RIVER OAKS DR STE 102
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City | JACKSON
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State | MS
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Zip | 39232-9539
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Country | US
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Telephone | 601-933-5660
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Fax | 601-933-5670
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Provider Business Mailing Address
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Address Line | 971 LAKELAND DR STE 1460
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City | JACKSON
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State | MS
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Zip | 39216-4621
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Country | US
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Telephone | 601-957-7340
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD L YELVERTON
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Credential | MD
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Telephone | 601-957-7340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 04433
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License Number State | MS
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