Provider Demographics
NPI:1275537029
Name:YOCHIM, GARY E (DO)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:E
Last Name:YOCHIM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 WALLACE AVE
Mailing Address - Street 2:STE 301
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42754-1418
Mailing Address - Country:US
Mailing Address - Phone:270-259-9651
Mailing Address - Fax:
Practice Address - Street 1:910 WALLACE AVE
Practice Address - Street 2:STE 301
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-1418
Practice Address - Country:US
Practice Address - Phone:270-259-9651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02348207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1055548OtherPASSPORT
KY000000245561OtherANTHEM
KY2433779000OtherPASSPORT ADVANTAGE
KY64023484Medicaid
KY64023484Medicaid
KY0301507Medicare PIN