Provider Demographics
NPI:1144409145
Name:YURKANIN, J PAUL (MD)
Entity Type:Individual
Prefix:
First Name:J
Middle Name:PAUL
Last Name:YURKANIN
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 1:5240 E KNIGHT DRIVE SUITE 108
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2122
Mailing Address - Country:US
Mailing Address - Phone:520-321-4266
Mailing Address - Fax:520-321-4048
Practice Address - Street 1:5240 E. KNIGHT DRIVE
Practice Address - Street 2:SUITE 108
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2122
Practice Address - Country:US
Practice Address - Phone:520-321-4266
Practice Address - Fax:520-321-4048
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-26
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31170208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ855439Medicaid
AZ855439Medicaid
AZH86038Medicare UPIN