Provider Demographics
NPI:1093724825
Name:YAWN, PETER MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:MICHAEL
Last Name:YAWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 109TH AVE NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-3602
Mailing Address - Country:US
Mailing Address - Phone:763-581-5550
Mailing Address - Fax:
Practice Address - Street 1:1420 109TH AVE NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-3602
Practice Address - Country:US
Practice Address - Phone:763-581-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48807207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine