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General NPI Number Information
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NPI Number | 1639102692
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Entity Type | Individual
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Provider Name | DOUGLAS HAROLD YOCK JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 05/16/2008
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Provider Practice Location Address
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Address Line | 800 E 28TH ST
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City | MINNEAPOLIS
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State | MN
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Zip | 55407-3723
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Country | US
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Telephone | 612-863-5195
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Fax | 612-863-2597
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Provider Business Mailing Address
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Address Line | 4700 LAKEVIEW DR
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City | EDINA
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State | MN
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Zip | 55424-1520
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Country | US
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Telephone | 952-920-4777
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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 | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | 23688
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | G27488
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License Number State | CA
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