MEDICARE: CHARLES F YACKULIC MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	L1244	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003909672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES F YACKULIC MD

Provider Business Mailing Address
First Line	:	914 N LOCUST ST
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76201-2954
Country	:	US
Telephone Number	:	940-387-6250
Fax Number	:	940-387-6274

Provider Business Practice Location Address
First Line	:	914 N LOCUST ST
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76201-2954
Country	:	US
Telephone Number	:	940-387-6250
Fax Number	:	940-387-6274

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	11/23/2009

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