Provider Demographics
NPI:1366443129
Name:YAHANDA, ALAN M (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:M
Last Name:YAHANDA
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:PO BOX 955534
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-5534
Mailing Address - Country:US
Mailing Address - Phone:636-498-5973
Mailing Address - Fax:
Practice Address - Street 1:3440 DE PAUL LN STE 110A
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-3546
Practice Address - Country:US
Practice Address - Phone:314-209-5225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA071202208600000X
MO20210006192086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2030304Medicaid
MI104435249Medicaid
IN200280990Medicaid
INP00702885Medicare PIN
IN149110VMedicare PIN
IN200280990Medicaid
IN667640MMedicare PIN
INE90924Medicare UPIN
IN150640DDDMedicare PIN
IN020047744Medicare PIN