Provider Demographics
NPI:1326021353
Name:YANG, GEORGE D (DO)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:D
Last Name:YANG
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 1:147 MOURNING DOVE DR
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-9476
Mailing Address - Country:US
Mailing Address - Phone:303-918-9186
Mailing Address - Fax:
Practice Address - Street 1:147 MOURNING DOVE DR
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-9476
Practice Address - Country:US
Practice Address - Phone:303-918-9186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014623207P00000X, 207PE0004X
CO48325207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO85520284Medicaid
GY014623OtherBLUE CROSS BLUE SHIELD
P00158345OtherRAILROAD MEDICARE
MI4639688Medicaid
MI4639679Medicaid
MI4639703Medicaid
MI4639688Medicaid
CO85520284Medicaid
MIB56088092Medicare Oscar/Certification