MEDICARE: DANIEL ALBERTO YELFIMOV 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	208800000X	Urology Physician	Q4550	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01088498	OTHER	MN	MEDICARE RAILROAD

General Provider Information

NPI Number	:	1720309685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL ALBERTO YELFIMOV M.D.

Provider Business Mailing Address
First Line	:	7909 FREDERICKSBURG ROAD, SUITE 110
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3400
Country	:	US
Telephone Number	:	210-614-4544
Fax Number	:	210-679-3713

Provider Business Practice Location Address
First Line	:	7909 FREDERICKSBURG ROAD SUITE 130
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3400
Country	:	US
Telephone Number	:	210-614-4544
Fax Number	:	210-679-3713

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

Provider Enumeration Date	:	06/15/2010
Last Update Date	:	01/12/2016

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