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NPI Code Detail

MEDICARE: DR. JESSE YARBROUGH DO

MEDICARE:  DR. JESSE  YARBROUGH  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
1390200000XStudent in an Organized Health Care Education/Training ProgramMI

General Provider Information

NPI Number : 1639532260
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JESSE YARBROUGH DO
Provider Business Mailing Address
First Line : 2611 N WILSON AVE
Second Line :
City : ROYAL OAK
State : MI
Zip : 48073-4226
Country : US
Telephone Number : 248-763-2412
Fax Number :
Provider Business Practice Location Address
First Line : 2611 N WILSON AVE
Second Line :
City : ROYAL OAK
State : MI
Zip : 48073-4226
Country : US
Telephone Number : 248-763-2412
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2016
Last Update Date : 03/31/2016

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Directions to “ DR. JESSE YARBROUGH DO” Practice Location

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