MEDICARE: DR. G PAUL YAZDI M.D.

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	208600000X	Surgery Physician	R2P61	MO

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	:	1265477806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. G PAUL YAZDI M.D.

Provider Business Mailing Address
First Line	:	670 MASON RIDGE CENTER DR
Second Line	:	STE 300
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8573
Country	:	US
Telephone Number	:	314-996-7777
Fax Number	:	314-996-4073

Provider Business Practice Location Address
First Line	:	3023 N BALLAS RD
Second Line	:	SUITE 675D
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-2330
Country	:	US
Telephone Number	:	314-996-7777
Fax Number	:	314-996-4073

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

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	03/31/2021

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