Basic Information
| Provider Information | |||||||||
| NPI: | 1265652424 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YEAGER | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | DONALD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 550 | ||||||||
| Address2: | |||||||||
| City: | AMBOY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986010030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602476520 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6000 KANAKANAK ROAD | ||||||||
| Address2: | |||||||||
| City: | DILLINGHAM | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9078425201 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 2510 | AK | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.