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NPI Code Detail

MEDICARE: PETER ANDREW YALCH MD

MEDICARE: PETER ANDREW YALCH 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
1207Q00000XFamily Medicine Physician35.075420OH
2207Q00000XFamily Medicine PhysicianME110548FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P01197933OTHERFLRR MEDICARE

General Provider Information

NPI Number : 1255388922
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER ANDREW YALCH MD
Provider Business Mailing Address
First Line : PO BOX 45443
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84145-0443
Country : US
Telephone Number : 904-202-1032
Fax Number : 904-376-4107
Provider Business Practice Location Address
First Line : 10337 SAN JOSE BLVD STE 200
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32257-8223
Country : US
Telephone Number : 904-260-3200
Fax Number : 904-262-8205
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2006
Last Update Date : 12/28/2018

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Directions to “ PETER ANDREW YALCH MD” Practice Location

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