Provider Demographics
NPI:1235115585
Name:YEOMAN, STUART G
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:G
Last Name:YEOMAN
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 1:1791 ASHLEY CIR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-3339
Mailing Address - Country:US
Mailing Address - Phone:270-781-4090
Mailing Address - Fax:270-842-3133
Practice Address - Street 1:1791 ASHLEY CIR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3339
Practice Address - Country:US
Practice Address - Phone:270-781-4090
Practice Address - Fax:270-842-3133
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19176207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCH4189OtherRAILROAD MEDICARE
KY0000053949OtherBLUE CROSS BLUE SHIELD
KY611356450OtherTAX ID#
KYCH4189OtherRAILROAD MEDICARE
KY0623104Medicare ID - Type Unspecified