Provider Demographics
NPI:1265477459
Name:YABLON, STUART A (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:A
Last Name:YABLON
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 1:909 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1520
Mailing Address - Country:US
Mailing Address - Phone:214-820-9391
Mailing Address - Fax:214-820-9339
Practice Address - Street 1:235 WEALTHY ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-5247
Practice Address - Country:US
Practice Address - Phone:616-840-8005
Practice Address - Fax:616-840-9642
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5281208100000X
MS15056208100000X
MI4301116605208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00117314Medicaid
TX8BZ365OtherBCBSTX
TX134926809Medicaid
TX8BZ365OtherBCBSTX
TX134926809Medicaid
MS250000070Medicare ID - Type Unspecified
TX8L12678Medicare PIN