MEDICARE: DR. LEON JAY YODER DO

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	207RG0100X	Gastroenterology Physician	1728	OK

General Provider Information

NPI Number	:	1285621482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEON JAY YODER DO

Provider Business Mailing Address
First Line	:	1200 W CHEROKEE ST
Second Line	:
City	:	WAGONER
State	:	OK
Zip	:	74467-4624
Country	:	US
Telephone Number	:	918-485-1205
Fax Number	:

Provider Business Practice Location Address
First Line	:	1202 W CHEROKEE ST STE C
Second Line	:
City	:	WAGONER
State	:	OK
Zip	:	74467-4629
Country	:	US
Telephone Number	:	918-485-1205
Fax Number	:	918-485-1695

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

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	08/30/2021

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