Provider Demographics
NPI:1255323978
Name:YRASTORZA, DAVID GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:GREGORY
Last Name:YRASTORZA
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 1:3670 INNOVATION DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33812-4105
Mailing Address - Country:US
Mailing Address - Phone:863-686-2282
Mailing Address - Fax:863-686-2370
Practice Address - Street 1:3670 INNOVATION DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33812-4105
Practice Address - Country:US
Practice Address - Phone:863-686-2282
Practice Address - Fax:863-686-2370
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66580207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2053Medicare ID - Type Unspecified
FLF87810Medicare UPIN