Provider Demographics
NPI:1073530671
Name:YEAGER, SUSAN M (DPM)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:YEAGER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 COOK ST
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-1882
Mailing Address - Country:US
Mailing Address - Phone:731-885-0220
Mailing Address - Fax:
Practice Address - Street 1:429 REDCLIFF DR STE 100
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0167
Practice Address - Country:US
Practice Address - Phone:731-286-2139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3136213ES0103X
TN820213ES0103X
MS80215213ES0131X
CAE5322213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery