Provider Demographics
NPI:1194374769
Name:YERGER, MICHAEL DAVID
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:YERGER
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 1:710 HAWTHORNE LOOP
Mailing Address - Street 2:
Mailing Address - City:DRIFTWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78619-4450
Mailing Address - Country:US
Mailing Address - Phone:512-970-3439
Mailing Address - Fax:
Practice Address - Street 1:710 HAWTHORNE LOOP
Practice Address - Street 2:
Practice Address - City:DRIFTWOOD
Practice Address - State:TX
Practice Address - Zip Code:78619-4450
Practice Address - Country:US
Practice Address - Phone:512-970-3439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider