Provider Demographics
NPI:1033519277
Name:YEAGER, RUSS FLINN
Entity Type:Individual
Prefix:
First Name:RUSS
Middle Name:FLINN
Last Name:YEAGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 ROUND ROCK WEST DR
Mailing Address - Street 2:SUITE 100-D
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-5052
Mailing Address - Country:US
Mailing Address - Phone:512-341-3700
Mailing Address - Fax:512-341-3738
Practice Address - Street 1:555 ROUND ROCK WEST DR
Practice Address - Street 2:SUITE 100-D
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-5052
Practice Address - Country:US
Practice Address - Phone:512-341-3700
Practice Address - Fax:512-341-3738
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1576222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist