Provider Demographics
NPI:1265477962
Name:YERGER, JAMES M (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:YERGER
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 1:435 S EAGLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6067
Mailing Address - Country:US
Mailing Address - Phone:208-939-8200
Mailing Address - Fax:208-939-8222
Practice Address - Street 1:435 S EAGLE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6067
Practice Address - Country:US
Practice Address - Phone:208-939-8200
Practice Address - Fax:208-939-8222
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM9368207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807226700Medicaid
I38149Medicare UPIN
ID807226700Medicaid
P00270571Medicare PIN