MEDICARE: GEORGE D YANG 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	207P00000X	Emergency Medicine Physician	5101014623	MI
2	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	5101014623	MI
3	207P00000X	Emergency Medicine Physician	48325	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00158345	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	GY014623	OTHER	BLUE CROSS BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326021353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE D YANG DO

Provider Business Mailing Address
First Line	:	147 MOURNING DOVE DR
Second Line	:
City	:	CANON CITY
State	:	CO
Zip	:	81212-9476
Country	:	US
Telephone Number	:	303-918-9186
Fax Number	:

Provider Business Practice Location Address
First Line	:	147 MOURNING DOVE DR
Second Line	:
City	:	CANON CITY
State	:	CO
Zip	:	81212-9476
Country	:	US
Telephone Number	:	303-918-9186
Fax Number	:

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

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	06/01/2021

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Directions to “ GEORGE D YANG DO” Practice Location

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