Provider Demographics
NPI:1003915760
Name:YAGER, ROBERT G JR (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:YAGER
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:DURYEA
Mailing Address - State:PA
Mailing Address - Zip Code:18642-1532
Mailing Address - Country:US
Mailing Address - Phone:570-430-3310
Mailing Address - Fax:570-586-2714
Practice Address - Street 1:123 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:DURYEA
Practice Address - State:PA
Practice Address - Zip Code:18642-1532
Practice Address - Country:US
Practice Address - Phone:570-647-2888
Practice Address - Fax:570-586-2714
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008295L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1544268Medicaid
PA1544268Medicaid
PA158147Medicare PIN